Coronalinks 4/10: Second Derivative

The second derivative is the rate of growth of the rate of growth. Over the past few weeks, the second derivative of total coronavirus cases switched from positive (typical of exponential growth) to zero or negative (typical of linear or sublinear growth) in most European countries. Over the past few days, it switched from positive to zero/negative in the United States and the world as a whole. These are graphs of the rate of growth – notice how they go from shooting upward to being basically horizontal or downward-sloping (source).



This graph shows the numbers a little differently, (source), but you can see the same process going on in individual US cities:

It would be premature to say we’re now winning the war on coronavirus. But we’ve stopped actively losing ground. If we were going to win, our first sign would be something like this. Current containment strategies are working.

As before, feel free to treat this as an open thread for all coronavirus-related issues. Everything here is speculative and not intended as medical advice.

The Bat Flu

SSC reader Trevor Klee has a great article on why humans keep getting diseases from bats (eg Ebola, SARS, Marburg virus, Nipah virus, coronavirus). He explains that because bats expend so much energy flying, they run higher body temperatures than other mammals, which degrades their DNA. Their DNA is such a mess that the usual immune system strategy of targeting suspicious DNA doesn’t work, so they accept constant low-grade infection with a bunch of viruses as a cost of doing business. Sometimes those viruses cross to humans, and then we get another bat-borne disease.

Subreddit user nodding_and_smiling doesn’t quite buy it:

I don’t think deep-diving into the bat immune system, while certainly very interesting, is necessary to explain the number zoonotic diseases from bats. I think a more important point is there is just a crazy number of bats, and the post doesn’t seem to fully appreciate this.

There are over 1,250 bat species in existence. This is about one fifth of all mammal species. Just to get a sense of this, let me ask a modified version of the question in the title:

“Why do human beings keep getting viruses from cows, sheep, horses, pigs, deer, bears, dogs, seals, cats, foxes, weasels, chimpanzees, monkeys, hares, and rabbits?”

That list contains species from four major mammal clades: ungulates (257 species), carnivora (270), primates (~300), and lagomorphs (91). Adding all these together, we don’t even get to 3/4 of the total number of bat species…

Read the full comment (and the ensuing discussion) for more, including whether biodiversity vs raw numbers is the appropriate measure here.

Mail Suffrage

The Wisconsin Democratic primary (plus some unrelated elections) went ahead as usual this week, with people going out to voting booths instead of voting by mail. Democrats wanted to allow (mandate?) mail voting, but Republicans refused.

Presumably Republicans assumed mail voting would benefit Democrats? The last time a state instituted vote-by-mail, in New Jersey, it did seem to increase the Democratic share of the vote.

I’m surprised by this, because I would have expected mail voting, as opposed to booth voting, benefits people with good executive function who are familiar with doing things by mail – ie older, richer people, ie Republicans. It would appear that I am wrong.

What if the epidemic isn’t done by November? There will probably be a discussion of lifting the shutdown to have a normal election, vs. voting entirely by mail, vs. combination where people who want to vote by mail can but the polls are open for everyone else. I don’t know if the second option is in the Overton Window right now (or if it should be). The party lines here seem to be the same: Nancy Pelosi is already pushing for it, and conservatives are already denouncing it as a liberal plot.

I’m in favor, obviously, but also terrified that something goes wrong. In one scenario, failure to agree on vote-by-mail rules (or failure to implement them competently) delays the election, with no clear way to get it back on track. In another, the sudden panicked switch to a less-tested voting method goes wrong in unpredictable ways and creates ambiguity over election results. It could be Bush v. Gore x 1000.

The Neoliberal Project has an analysis of what we should do and how to make postal voting work. I just really hope it doesn’t come to this.

Charity Update

Last week I linked a list of potentially good coronavirus charities cobbled together by some random people on the EA forum. Now a more serious organization, 80,000 Hours, has posted their own list.

The top option is still the Johns Hopkins Center for Health Security, which researches and advocates for biosecurity policy. Last week someone in the comments doubted the quality of their work, pointing out that one of their flagship efforts is a ranking of how prepared different countries are for a global pandemic; their 2019 listing put the US at the top, which now feels like a cruel joke. But I’m not sure how much to hold it against them. Looking at their webpage, it mostly investigates whether a country has good plans addressing various issues of a crisis, and lots of resources that it can deploy if needed. As best I can tell, the US had great plans and didn’t follow any of them, and lots of resources which it totally failed to deploy effectively. Responsible think tanks are probably not allowed to add a -10000 points at the end of their analysis for “but its leaders are idiots”. This might still be a good time to reread Samzdat on hokey country rankings and no_bear_so_low on hokey country rankings.

Speaking of charity, you can read on Twitter about the trials and tribulations of people trying to donate face masks to hospitals, and here’s an article from three years ago about issuing pandemic bonds as a novel insurance-type way of funding global disease response. Pretty neat.

And you might think that a page called The COVID Challenge where you sign up to deliberately get infected with coronavirus is a bad idea, but it’s actually some volunteers trying to make a list of people who would be willing to get deliberately infected (if it came to that) in order to test vaccines, which they will hand over to vaccine-makers once they get to the testing stage. Rationalist John Beshir did something like this for a malaria vaccine last year and earned $3200 (plus the warm glow of having made a difference) by letting himself getting bitten by infected mosquitoes in an Oxford laboratory.

There Is No Coronavirus In Ba Sing Se

Turkmenistan is a strange country. You probably remember it for its wacky former dictator Turkmenbashi, who among other things renamed the month of March after his mother, and told citizens that anyone who read his book three times would enter Heaven. Or for its wacky current dictator Gurbanguly Berdymukhamedov, who NPR describes as a “dentist/rapper/strongman”. Or for its impressive accomplishment of beating out North Korea to be named the most repressive country on Earth by Reporters Without Borders.

Its coronavirus response will do nothing to improve its reputation: early reports claimed it had banned mentioning the word ‘coronavirus’ or acknowledging its existence in any way.

The Diplomat argues this is not quite true; some state media seems to be using the word. But they are definitely arresting people for talking about it outside official government organs, and they are definitely denying that there are any cases in the country. Since Turkmenistan is right next to Iran, which has had thousands of cases for months, this is pretty implausible.

The Diplomat also requests that people try not to focus on the country’s wacky dictators so much every time they talk about it, since that makes it hard to get people to take its suffering seriously. Sorry, Diplomat and Turkmen people 🙁

And SSC reader Castilho describes their home country of Brazil, which seems to be right up there with Turkmenistan:

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

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

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

Read the full comment for more.

And last month I wondered about the surprisingly slow spread of cases in Iran. I can’t find anyone saying so outright, but it seems like the numbers are probably wrong. At least that’s what I gather from articles like this and Twitter accounts like this highlighting the scale of the crisis there, which seems at least as bad as anywhere in the world. I don’t know if they’re deliberately lying about case numbers (why start now, after the numbers were so bad a few weeks ago?) or if testing has just completely broken down there. See also this article on how their form of government has led to power struggles and a garbled response. I would say something mean about radical Islamic fundamentalism, except that the whole thing mirrors blow for blow what happened between Cuomo and de Blasio in New York.

And finally, here’s a great article on the mystery of Japan. Tl;dr: cultural traditions like mask-wearing and bowing helped it for a while, crowded trains aren’t as bad as you’d think because nobody’s talking, banning large gatherings very early was a really good move, their weak half-hearted version of test-and-trace worked for a while out of sheer luck, but now cases are finally starting to rise and there probably won’t be a mystery to explain for much longer.

Economic Unanimity

The IGM Economics Experts Panel surveys a view dozen top economists on the issues of the day. This month they’re focusing on coronavirus. Here are some sample results:

…they pretty unanimously support the lockdown, even when asked only to reflect on its economic impact.

Some socialists on social media are trying to spread a narrative where capitalists think the economy is more important than lives and want to lift the lockdown immediately, and it’s only socialists who are standing up for the importance of saving people. Top economists aren’t a perfect stand-in for capitalists, but it’s still pretty clear that they’re wrong.

Also, there are starting to be some econ papers trying to more rigorously analyze the pros and cons of lockdown. The Benefits and Costs of Flattening the Curve for COVID-19 says that “assuming that social distancing measures can substantially reduce contacts among individuals, we find net benefits of roughly $5 trillion in our benchmark scenario”.

USA! USA!

Is there anything Americans can be proud of here?

@noahpinion reminds us of America’s long history of being late on the trigger but doing a great job once we get started (Churchill: “You can always count on Americans to do the right thing – after they’ve tried everything else.”). We were late entrants into both World Wars but had an outsized effect on both of them. In that spirit, although we were very slow to start testing, we’ve ramped up impressively fast – from almost none to 1/3 of South Korean levels per capita within a few weeks.

Also worth celebrating – during the Wuhan phase of the pandemic, China built an impromptu 1,000 patient hospital in ten days. US media reported this as unbelievable – a sign that a young and vigorous country could accomplish feats that a decadent America could never dream of. But last week in New York, the Army Corps of Engineers converted the Javits Convention Center into an impromptu 2,000 patient hospital in…about ten days.

I don’t know, maybe this was easier because they’re converting an existing structure instead of building a whole new one (though even the Chinese used prefab units). But it’s nice to know we still have it in us to do things quickly. There’s no civilizational decline. If the government ever legalized building things quickly again, we’d be mopping the floor with China within weeks.

Legal Immunity

There’s a Jewish legal principle called marit ayin, which means that it’s illegal to do something which is legal but looks illegal. For example, you can’t eat some kind of plant-based Impossible Bacon, because it would look like you were eating real bacon. Some authorities say it is sometimes permissible to eat the Impossible Bacon if you leave the box out in a prominent position so that it doesn’t look illegal; I’m not sure of the details.

The argument is that widespread flagrant unpunished violation of the law makes the law uncompelling and unenforceable, and this is true whether the violation is real or imagined. If you never see anyone eat bacon, you probably won’t eat it yourself; if everyone around you seems to be eating bacon all the time, it feels less taboo. Also, if you’re a police officer, it’s hard to identify the real bacon eaters if there are a bunch of people eating Impossible Bacon who get annoyed every time you question them.

I was thinking about this recently with the news that Germany is considering issuing immunity certificates for people who have gotten coronavirus, recovered, and are now safe to do normal activities. It’s a good idea, but suffers from the same problem as Impossible Bacon – if there are hundreds of people going outside maskless, eating at restaurants, and sunning themselves on the beach, it’s going to be hard for the rest of us to take lockdown seriously enough.

The equivalent of the rabbis’ put-the-box-out solution would be for governments to issue not just a certificate but some kind of unique article of clothing people could wear to mark their status. For example, they might give an unusually shaped red cap – if the beaches are full of people in red caps, that’s fine and doesn’t say anything about whether you personally should go sunbathe. And if the beachgoers see someone without a red cap, they can question them or keep their distance.

This would take a lot of centralized coordination, though. I’m not sure how you could send the same message without a government order explaining what the cap meant to everybody. Though (as per this Onion article) wearing a fake pangolin snout over your nose would send a strong signal.

A reader who has overcome the disease emailed me to ask whether there are any useful volunteer opportunities for people like him – anyone have any advice?

Short Links

Last week I expressed confusion about how to measure population density so that arbitrary choices of border don’t distort the results. Commenters delivered by finding me this article on population-weighted density, which solves my theoretical concerns but doesn’t really change any of the numbers much.

The Netherlands is another country which, like Sweden and Brazil, is volunteering to be the control group for the great experiment of whether national lockdowns work. Maybe someone should compare them to Belgium or somewhere like that in a few months and see how they did.

An aircraft carrier captain publicly complained that the Navy was failing to address an epidemic aboard his ship; the Navy fired him for whistleblowing. I’m having a hard time thinking of any perspective other than “the Navy is bad and should be torn down totally to the foundations, preferably using some sort of land-based weapon so they can’t fight back”, but here’s a different ex-captain trying his best to give a nuanced perspective.

Say what you will about the New York Times’ coverage lately, but their cover design remains second to none.

This Tumblr post has a discussion of how/whether a Clinton administration might have responded differently to the pandemic, but the part I like is the discussion of the phrase “follow the pandemic response playbook”. It turns out this is a literal document, called the Playbook For Early Response To High Consequence Emerging Infectious Disease Threats And Biological Incidents, and you can read it here.

Marginal Revolution: are hospitals really saving that many people?

UK clinical guideline body NICE now officially recommends against using NSAIDs for coronavirus. Still not completely proven, but I think they’re right to advise caution. While most experts themselves behaved appropriately, this is more egg on the face of the media, which until a few weeks ago was running stories telling people this was a myth and they should ignore it.

538 surveyed infectious disease experts around the US, asking them to predict the number of cases in X days’ time, with confidence intervals. The results are in, and the experts did worse than just continuing the exponential curve on the graph would have. EDIT: But see here.

If you’re following Robin Hanson’s variolation proposals, you can watch Hanson debate vs. Zvi Moskowitz and vs. Greg Cochran (and here’s Cowen on Hanson). Anyway, viral dose seems to have gone mainstream, though nobody seems to be doing anything about it yet.

The two different interpretations of “flatten the curve”. I think this explains why so much of the discussion around this phrase has been confusing.

Trump Asks Medical Supply Firm 3M To Stop Selling N95 Respirators To Canada, and also Key Medical Supplies Were Shipped From US Manufacturers To Foreign Buyers. I think we’re supposed to be outraged about both of those things simultaneously but I can’t manage it, maybe some of you will have better luck.

How much risk do young people really face from coronavirus? What are the risks of long-term complications? Sarah C investigates.

Last week, Elon Musk got widespread praise (including here) for donating a thousand ventilators he managed to procure through his Tesla supply chain. Now the picture has become more confusing. Reporters looking at a picture of his shipment noticed that the boxes pictured are for BiPAP machines – technically a kind of ventilator, but not the kind hospitals need to fight coronavirus. Was the whole thing a giant mistake or cynical PR stunt? But then some hospitals tweeted thanking Tesla specifically for delivering “Medtronic invasive ventilators”, which are the kind hospitals need to fight coronavirus. Some people are theorizing that maybe hospitals don’t want to offend Musk since he might have real ventilators later, other people that maybe Musk got both some useful and some non-useful ventilators in his shipment. I dunno. In any case, he’s still promising to make some at Tesla factories, though.

829 thoughts on “Coronalinks 4/10: Second Derivative

  1. vonnik

    Idle speculation: Maybe species with consistently high body temperatures are more likely to speciate faster, which would mean that Trevor Klee and nodding_and_smiling are making the same point.

  2. SCC

    I have said this before, but I am going to say it again.

    If you think you are an expert on a human phenomenon, say, the stock market, the derivatives market, getting students to learn a foreign language – you may very well be an expert.
    If you think you are an expert on a natural phenomenon – say, a virus that is descended from a billion years of viruses that have outwitted a billion years of victims, all without trying – then you are a dangerous imbecile.

    There are exceptions to this rule.

    Ponder the case of Ramanujan, who loved natural numbers, even stunningly big numbers, as a friend loves a friend. Due to his great love for those generally unloved creatures, he had deep and expert insight —– unlike the typical math professor who spends several years focusing on some sweaty subject and thinks he is worthy of a prize because he adds some incremental kludge to a vast body of specialized knowledge.

    Think of those saints who could heal the mentally ill merely by praying for them and looking in their eyes with an expression of kindness —- because they focused their whole lives on the love God has for all of us, including you and me.

    And then there is my theory, that humans are subject to the exact amount of failure it has taken to keep us from ruining the world, in general, and that even the craftiest of us are limited by that historically necessary fact —-

    except for those few humans who are angelically inspired, almost all of whom are people you have not heard about, but some of whom invented things or discovered hidden beauties which helped our civilizations to be the best that they could be.

    That, my friends, is the most important thing you will read today on the internets about the history of civilization.

    If you are interested in the topical questions of the day, I can tell you how the Chinese are in general a good-hearted people, and one of the worst aspects of this disaster is the bumbling 4 weeks (on the part of less than a few dozen Chinese people) that sealed the fate of hundreds of millions, to the embarrassment of the huge majority of good Chinese people, I can tell you how happy many of the mathy people who are most vocal about reactions to the coronavirus are that they have been blessed to have their spergerian gifts at a time like this when they can be what spergerians all want to be (trust me, you do not want what they want, you do not even want to know what they want), I can tell you an awful lot about who regrets what and who will be forgiven, in their own hearts, and who will not be.

    I can but I won’t, you know almost as much as me, we are all human, and not many of us are all that different from each other. God loves us all, my advice is to just ask for a moment or two of angelic inspiration, but remember not to ever ever ask for anything that would be harmful to your soul or that would involve unkindness on your part to others. AMDG

  3. ec429

    some kind of unique article of clothing people could wear to mark their status

    Maybe it’s because you’d just been talking about Jewish law, but the first place my mind went with this was (sarcastically) “I know! How about we make them all wear little yellow stars!”

  4. ThaomasH

    For tracking “the curve” I use an log(y)=ax^2+bx+c regression. “a” is the indication of the second derivative of days we want. For both states and counties it works pretty well when the absolute numbers are not too small. (I does not work will for Vatican City.) For new cases the F’s are mostly pretty large. Deaths (smaller numbers?) do not work nearly as well. Maybe that’s because more deaths are still from non-community spreading, which is not what the functional form of the regression is looking for.

  5. thoramboinensis

    Re: Bat flu, the Klee post seems to almost exactly recapitulate the hypothesis advanced by this recent paper, without citing it. The summary here doesn’t do either real justice though. That explanation is best at justifying why zoonoses from bats are so virulent, not so common. The reason why they are so common probably has more to do with the number of bat species out there, with maybe an assist from their large colony sizes, frequent interactions between species, and shared arthropod vectors. The likelihood of a zoonotic spillover is proportional to the number of species in a group and inversely proportional to relatedness of that group to humans. The big mystery with bats is more that the zoonoses from them tend to be way nastier than zoonoses from other groups. Partly that’s explained by relatedness also–the viruses from more distantly related groups are deadlier when they do make it into humans–but that’s not a mechanistic explanation plus bat viruses still are an outlier in that analysis (and are an outsize reason for the trend), hence the need for an explanation like Brook et al (first link).

  6. 1

    A quick comment about voting by mail. The Republican concern is that there’s higher voter fraud with mail order ballot. That’s why they are opposed to its expansion.

  7. DNM

    A few weeks ago much of the country entered lockdown to “flatten the curve”. Much of what I read at the time claimed that flattening the curve wouldn’t necessarily significantly affect the total number of cases, but that it would affect the number of deaths substantially as the medical system would have the resources to give the best care possible to those who needed it.

    Lately I have seen much less talk of flattening the curve. Perhaps the medical system’s effect on patient outcomes is simply too small for the impact of avoiding overwhelm to be what we hoped? Now all the talk seems to be that we are sheltering in place until we have the ability to test / maybe antibody test literally everyone, and/or until we have very effective treatments (at which point, will flattening the curve become the approach again)?

    1. albatross11

      There are different meanings to the phrase, and honestly I don’t think anyone knows what’s going on well enough to have a lot of confidence in their predictions.

      One goal is to spread out the infections so we don’t overwhelm the hospitals. Given the reported state of NYC hospitals, the lockdowns around there probably came at the last moment to have the desired effect locally, but how well this will work nationally remains to be seen. The underlying assumption here, as I understand it, is that we will probably all get this crap sooner or later, but delaying when people get it will keep the hospitals from being flooded all at once, will give doctors and scientists time to work out better treatments, and will maybe get the critical hospital staff through the infection and immune so there are enough doctors and nurses and respiratory therapists and such to go around. If it turns out that we can’t stop the spread of the disease, then this is the best we can do.

      A second goal is to stomp on the spread of the disease while we ramp up testing, production of protective equipment like N95 masks, and so on, and then take measures to keep the disease from spreading until we have a widely available vaccine. During the lockdowns, my guess is that nearly all the spread is happening in hospitals and nursing homes. The number of people each infected person interacts with in the community is way down, and most of those interactions are likely to be at a 6 foot distance with both people wearing masks and using hand sanitizer after interacting. It’s quite likely that the average infected person infects less than one other infected person

      When we relax the lockdown, things might go in several directions:

      a. We could test and quarantine people effectively enough that we prevent the spread of the disease–basically keeping the number of new infections per infected person down below 1.

      b. We could have a big flare-up where the number of new infections per infected person goes back up above 2, and we get a new rapid increase in cases and hospitals filling up again in a month or so.

      c. We could somehow live between those two worlds, marginally keeping a lid on the disease until it spreads to enough people (most people) that it can no longer spread very well and we finally get rid of it.

      Nobody knows enough to know how this will work. If immunity falls off after a couple months or the virus just comes back in many people after a couple months, then we’re probably living in (b) or at best (c). Also, if there’s a lot of airborne spread (tiny droplets that stay aloft for hours) from asymptomatic people, probably we’re going to experience (b), because nothing much short of the lockdowns will stop spread in the community. If we get cheap, widely-available, accurate rapid tests for both virus and antibody, immunity lasts for at least a couple years, and masks + hand sanitizer + 6 feet of distance stops nearly all spread, then we can probably get to (a). If we finally roll out antibody testing and it turns out that half the population has already had this crap and is now immune, we can probably get to (a) and it’s also a little less urgent to get to (a) because it’s not quite as deadly as it looked at first.

    2. John Schilling

      The original concept of “flattening the curve”, as seen in graphics like this, was built around the idea of accepting the same number of cases but spreading them out over a longer period to avoid overwhelming the hospitals. This never held up to close scrutiny, as I think we’ve discussed here before. To avoid overwhelming the hospitals, even assuming we ramp up ventilator, etc, production so that trained personnel are the limiting factor, the curve would need to be so “flattened” as to spread out over at least a year, not the few months implied by the graphics. And even if you’re willing to wait that long, it would require a nigh-impossible balance to keep the curve at the right level of flatness.

      So we started to see new definitions of “flatten the curve”, that now meant suppressing new infections vigorously enough to greatly reduce their total number and nigh-eradicate the virus in a few months. Except, not literally eradicate the virus, so we either keep ourselves isolated for a year or so even though the crisis appears to have ended, or we end isolation prematurely and watch infections grow exponentially from almost none to right back where we started.

      There are some good plans for how to prevent this, and a lot of stupid unworkable plans for how to prevent this. “Flatten the curve” can now mean any or all of them, depending on who you are talking to, and is thus useless as a term. It basically means “whatever I think is the best plan today is what ‘flatten the curve’ means, and it meant that all along so shut up about how last month’s version was never going to work”. Look for your information and your hope among the subset of the people discussing COVID-19 without seriously using the phrase “flatten the curve”.

      1. Clutzy

        Except this is wrong. Flatten the curve, using the initial models that estimated over 2 million deaths was always a lie. If you looked at the timelines we would have had to keep going to keep ICU beds open we would have had to flatten for something like a decade (depending on your model of choice).

        1. Matt M

          Flatten the curve, using the initial models that estimated over 2 million deaths was always a lie.

          Weird… because some of us called it a lie back then, and were told we needed to shut up and “listen to the experts.”

          What do you suppose the experts are saying right now that, 2 weeks from now, everyone will happily accede was obviously a noble lie that was never meant to be taken literally?

    3. The Nybbler

      The lockdown either always was or has become its own justification. Governors like it because they can rule by decree. Police like it because it’s an excuse to lord it over everyone. Public health bureaucrats like it because it puts them in charge and means they don’t have to speed anything up — everyone waits on them. In Canada and Australia and the UK, they’re talking about lockdown until a vaccine is available, with no expediting of that process, so 18 months at the absolute minimum. In the US they’re just not giving any indication of ending — it’s just “many more weeks” in New Jersey, after which I suppose we can expect “many more weeks” again.

      Antibody tests? Unavailable; some companies tried to market rapid at-home ones and the FDA put the kibosh on that. Effective treatments? Unless some existing drug just happens to work, forget about it in 2020 or 2021.

      The lockdowns are going to continue until there’s significant rioting or sufficient danger of incumbents being voted out, and I don’t see that happening any time soon.

        1. The Nybbler

          At this point? Return to normal. We can’t stop it in the US (because we’re too late), we can’t eradicate it (too late, spread too widely, and it has at least one animal reservoir — cats), and we certainly can’t lock down long enough for a vaccine. Without eradication or a vaccine, it’ll come back whenever we release the lockdown, or so the models say. So, get it over with.

          1. anonymousskimmer

            do things to make doing so easier.

            Delivery services for vulnerable people (or preferably everyone) need to UV treat containers and packages.

          2. DNM

            And yet, DanielFriedman, as best I can tell that our current “overreaction” has exactly 0 protections for vulnerable people who work at essential jobs, until they actually get COVID. Quit your job? No unemployment for you.

      1. albatross11

        The Nybbler:

        Your imputed motives for everyone are bullshit, and you ought to try harder to actually understand the motivations of people before you critique them. No politician wants to cause his state’s economy to crater and his voters to be mad as hell and looking for alternatives when the next election rolls around, and the desire to rule by decree doesn’t override that. Public health bureaucrats are freaking the f–k out because they’re basically trying to pilot an airplane with both engines on fire and the instruction manual’s in Swahili. I’m sure there’s someone somewhere power-tripping, but mostly they’re scared and overwhelmed and way the hell out of their depth.

        Are people making some bad decisions? I’m sure they are. But they’re mostly making bad decisions because they’re in over their heads or don’t have very good data. Nobody really knows how COVID-19 spreads or how the disease progresses very well. I’ve been listening to TWIV, a podcast by academic virologists that often interviews experts in the relevant field, and they learn new things and realize everyone had it wrong about stuff w.r.t. COVID-19 all the damn time. Similarly, the best available information from CDC and WHO and every medical authority you can find keeps changing, because this is a new virus and biology, virology, immunology, and epidemiology are all really messy.

        The problem is, even without perfect information, we still have to figure out what to do. With a plague spreading around the world that looked to be set to infect most of the population and maybe kill half a percent of them, and the example of countries where the hospitals got overwhelmed and melted down, I think some kind of large-scale shutdown was inevitable, and in fact was the best policy that anyone was going to come up with. At the very least, that needed to involve shutting down schools, bars, concerts, and large public gatherings, and probably forbid restaurants from having people eat in.

        We clearly can’t keep the lockdowns in place forever. Hopefully we’re learning enough about the virus to step down from them without having the disease just flare right back up and having another explosion of sick people and meltdown of the health-care system in a couple months. And hopefully we can get some intelligent plans for any further local lockdowns that are needed if the disease flares up again in some city or region.

        And at the same time, it’s important to realize that a bunch of stuff is going to stay shut down, either because it’s too likely to be a point of spread of the virus (big crowded sporting events) or because the customers are going to stay away in droves (air travel has utterly cratered even though there’s nobody imposing a shutdown on flights).

        1. The Nybbler

          Eh, you assume good motives for everyone, I assume base ones. NJ has been making its lockdown rules stricter based on… absolutely no new information. That fits my theory (governors like to rule by decree) and fails to fit yours.

          We clearly can’t keep the lockdowns in place forever. Hopefully we’re learning enough about the virus to step down from them without having the disease just flare right back up and having another explosion of sick people and meltdown of the health-care system in a couple months.

          “Learning” doesn’t give us the ability to do that.

          And at the same time, it’s important to realize that a bunch of stuff is going to stay shut down, either because it’s too likely to be a point of spread of the virus (big crowded sporting events)

          So we’re going to severely curtail our lives indefinitely for fear of this virus?

          or because the customers are going to stay away in droves (air travel has utterly cratered even though there’s nobody imposing a shutdown on flights).

          There’s also almost nowhere to go, since international travel IS restricted and domestic destinations are mostly shut down.

          1. albatross11

            Learning definitely helps us know what restrictions make sense.

            Here’s a simple example: If we determine that asymptomatic people more-or-less never spread the virus via tiny airborne droplets that float around for a couple hours, then symptom checks plus normal social distancing (keep 6 feet between people in most circumstances, wash your hands regularly, everyone wears a mask in public) is enough to stop nearly all transmission in the community. Suddenly, we know how to reopen most businesses without getting a flare-up of COVID-19.

          2. The Nybbler

            You get new info every day with the case numbers.

            You only get new information that should result in a change in policy when they change in a way that was unexpected.

  8. realist50

    I very much discount the idea of national vote-by-mail. Elections are largely a state responsibility, so I expect different strategies on a state-by-state basis. The federal government has some involvement intervening if certain requirements aren’t met – for example, Voting Rights Act – but that’s of course usually subject to litigation in federal courts. That can be a lengthy process, and I’m also highly doubtful that the current Supreme Court majority would endorse any injunctions by judges premised on finding that the Voting Rights Act somehow mandates vote-by-mail nationally.

    Perhaps there are ways that the federal government could induce/coerce states to vote-by-mail (i.e., monetary grants), but I don’t see that as likely with a Republican Senate and President.

    Some other ideas that I think we might see:

    – Poll workers are generally elderly. Perhaps we’ll see a push toward recruiting poll workers who are verified as recovered from COVID-19, particularly if we have wider antibody testing. I could see state/local government and some larger corporations encouraging this behavior among their employees (e.g., paying employees for time spent training and then working on Election Day, akin to payment for jury duty).

    – For places with early voting – reportedly 39 states plus DC – https://www.ncsl.org/research/elections-and-campaigns/early-voting-in-state-elections.aspx – I could see expansions of early voting in an attempt to thin out Election Day crowds. Some of that might simply happen based on voters’ decisions, of course. Expansion of number of sites or duration of early voting does have some issues with needing poll workers.

  9. realist50

    “A reader who has overcome the disease emailed me to ask whether there are any useful volunteer opportunities for people like him – anyone have any advice?”

    +1 to an idea that I see above about donating plasma for convalescent therapy. The American Red Cross has an online form at its website – https://www.redcrossblood.org/donate-blood/dlp/plasma-donations-from-recovered-covid-19-patients.html

    Other suggestions that I have are Meals on Wheels, a local food bank, and/or any organization working with the homeless.

    My understanding is that Meals on Wheels has changed how it operates – at least it has where I live – but it still of course works with a high-risk population.

    One other point to consider is that many of the *volunteers* at these organizations are in the relatively high-risk population due to age. It’s of course very common for retirees to volunteer at these organizations, because they have the time to do so. I therefore assume that many of these organizations are having – or will have – some challenges in certain volunteers understandably deciding not to come in for their normal work.

    I mention charities dealing with the homeless because I assume that – at least at some point – the homeless population will be a high-risk vector for transmission due to time on the streets and lack of hand washing.

  10. Douglas Knight

    Did Clinton v Trump make a difference?

    Many people point to Europe and say that should be the baseline for technocratic governance; that we shouldn’t have expected Clinton do better than Macron and Merkel. But this assumes that France and Germany are sovereign states. Are they? How can we tell? Perhaps they take direction from POTUS, like Newsom and Cuomo.

  11. albatross11

    This chart is terrifying–a hell of a lot of small businesses are probably going to close as a result of this crisis.

    Note that ending the lockdown will help them some, but won’t fix their problems. Restaurant reservations started crashing as soon as COVID-19 was in the news, and won’t be all that popular as long as it’s still circulating and a risk. Those businesses are going to need a plan for returning to work that gives their customers some strong assurance that they’re not likely to catch the virus by doing business with them. For some, that’s probably doable, whereas for others, it looks very hard. (Realistically, how is a hairdresser supposed to avoid being close enough to you to give/receive an infection? Fever checks, masks and hand sanitizer are all great, but still….)

  12. albatross11

    There’s a chain of opticians/optometrists that has recently started following this list of safety precautions to avoid the spread of COVID-19 at their stores. This seems like a good example of something that can allow a business to reopen without adding a lot of opportunity for the virus to spread.

    As long as there’s not much airborne spread by asymptomatic patients, I think this will be pretty effective. I wonder if it would help for them to put a couple commercially-available HEPA air cleaners in the office to decrease the risk of airborne spread. (I’m not sure how much difference that would make, honestly.)

  13. jamesliudotcc

    Here is an Atlantic article that claims that we already have an effective vote by mail system in a lot of states, including most of the swing states that matter:

    https://www.theatlantic.com/politics/archive/2020/04/voting-mail-2020-race-between-biden-and-trump/609799/

    If you count the states that have no-excuse absentee voting and those that will allow “coronavirus” as an excuse, the hurdles are mostly logistical and not legal: the states need to print a bunch more vote by mail ballots and a lot less in-person voting ballots, and have the counting machinery to match. With 5+ months to go, that is entirely within the realm of possibility.

    I live in Washington state, which conducts vote by mail. Before that, I lived in Illinois, which allows one to select vote by mail at registration. After the November 2018 election when I saw the unexpectedly long lines for the last day of early voting, I got up early to beat the crowd at my normal polling station and voted by mail ever since.

    1. Edward Scizorhands

      That’s a great article that challenges a lot of assumptions from people on all sides. Thanks for sharing.

    2. albatross11

      My guess is that it’s entirely within the realm of possibility if the states start preparing now, but not if they wait until September and then decide to start preparing. And local election officials will probably need money that’s scarce in many state and county budgets to do so.

  14. tokugawa

    Scenario building exercise for our current predicament. A rolling, expansive mess of discovery

    https://twicefire.com/2020/forkcovid/

    Some take aways:

    1) My pessimism about federal and state coordination really undercuts many of the measures I think are necessary to deal with the challenge in the USA. There is strong evidence for this is causing problems already and I would not expect coordination to improve substantially for the time-being.

    2) Collectively the USA isn’t doing the test-and-trace legwork it needs to do today, to responsibly reopen parts of the country in the future;

    3) The USA needs the vaccine as its back-stop, before things can return to ‘normal’; This is a big claim and one worth a deep dive (It is what Canada seems to be working off). We are at best 12-18 months away from one of the many vaccine efforts getting widespread adoption. In essence, it is my view that the USA will struggle to consistently coordinate test-and-trace and appropriate movement restrictions to get things ‘under control’ before vaccines are likely to arrive in 2021. This happened because of #1 & #2

    4) We will be in a recession, if we are lucky. Economic depression is more likely.

    5) Events and large gatherings are done for the next 12-18 months; They will be reckless in the USA until herd-immunity. Which will depend on #3

    6) Enduring strain and shocks on food supply chain; how will the supply system cope? Very hard for me to gauge when this might occur.

    7) There will be some forms of restrictions until herd immunity/vaccine is reached; Because of #3

    8) One step closer to chaos (background risks of other issues/disasters remains the same; but now they hit when we are even less able to deal with them). Riots of ‘92 are an example (from thirty years ago) of how social unrest could get messy fast, even in the USA. This is a result of #4, #6, #7 and the general backdrop of chronic national emergency.

    9) Don’t try to read trends in the data on a day-by-day basis (week to week is probably more reliable)

    10) Non-essential overseas travel is basically off the table for 2020

    1. albatross11

      I agree on #1: My sense is that the federal response hasn’t been very good or well-coordinated, and that state/local responses are all over the map depending on local competence and resources. The one state I have inside knowledge of seems to be handling things pretty poorly, partly due to a kind of adminstrative meltdown at the state health department for reasons unrelated to COVID-19.

      So here’s a possibly-more-useful angle to consider. What can consumer-facing businesses do to convince their customers (accurately) that there is little risk to the customer from using their services? Think of restaurants, theaters, hairdressers, pool halls, concert venues, etc. Is there anything that would actually make a relatively high-risk person want to go to those places? This is a matter of some urgency for those businesses, because if they can’t get anyone scared of catching COVID-19 in the door, they’re looking at a huge fall in business, even after the lockdowns end.

      Restaurants already have a pretty good story to tell–they’re used to having to comply with health regs, they already have bleach sanitizer for tables and dishwashers that will sanitize their dishes and such, etc. Add temperature checks and masks and some distance between customers, and especially outdoor seating, and they can probably get a lot of business back. Even now, doing carry out is enough to keep many of them afloat, and when dining rooms reopen, probably a lot of restaurants will continue doing a lot of carry-out business.

      What the heck would a hairdresser have to do to convince, say, a 60 year old woman with COPD to come get her hair done? Masks and fever checks? Immunity certificates for all the employees? Weekly virus swabs? Plus keeping the number of people getting their hair done down enough to keep everyone several meters away? I’m not sure.

      The reason to want to see that is that it puts the incentives in the right place.

    2. The Nybbler

      We choose not to because regulators don’t think this is enough of an emergency to risk many vaccine trial patients getting sick and a small number of them dying.

      As the safety people will tell you, there’s no excuse for unsafe acts. Not even a pandemic. Why relax any of the absolutely necessary regulations we have built up over the years when we can simply shut down the economy until we have gone through the proper process?

      There’s no convincing people with that mindset. It’s been deliberately and effectively drilled into them, and literally _no_ excuse will work.

      1. nkurz

        While you may be right for the US, it would seem there would be an opportunity for a less safety-conscious country to take a faster approach. Do all other countries that have the infrastructure to do the vaccine development have the same mindset? Would the US utilize a vetted vaccine if another country made it available?

        1. albatross11

          From what I’ve read, there are vaccine development efforts going on in India, China, and France right now, so it’s not just the US and our FDA deciding what will be done.

    3. albatross11

      I see your point and largely agree that our safety/regulatory culture has shown a lot of bad features in this crisis. But we are talking about a vaccine that, in order to have the desired impact on society, has to be given to like 200-300 million otherwise healthy Americans. We definitely want as much assurance as possible that this isn’t going to lead to some kind of nasty problem down the road.

      My not-very-informed proposal would be to substitute numbers of participants for time. Effects that don’t manifest in anyone for 18 months won’t be caught (but that’s still true of effects that don’t manifest for five years even with the 18-month delay), but if we’ve got thousands of people in our safety trials up front, we’re very likely to catch any short-term health problems with the vaccine.

      The other source of delay is production–I think that’s where the Gates foundation’s decision to fund production lines for several promising vaccine candidates comes in.

      1. The Nybbler

        But we are talking about a vaccine that, in order to have the desired impact on society, has to be given to like 200-300 million otherwise healthy Americans.

        No, it doesn’t. One of the few convenient aspects of this disease is it kills and severely harms mostly the elderly and unhealthy. So a vaccine that protects those over 45, or even 65, gets you most of the benefit. A huge chunk of the tail risk goes away if you don’t give the vaccine to healthy people of reproductive age.

        We definitely want as much assurance as possible that this isn’t going to lead to some kind of nasty problem down the road.

        Since that’s open-ended (“as much assurance as possible”), it translates to not relaxing procedures in the slightest.

        1. Edward Scizorhands

          People over 65 are those in whom it is riskiest to test the vaccine, especially if you are doing human challenge as part of your testing.

        2. The Nybbler

          Riskier to the participants in the trial. But least risky in terms of mass rollout. If the vaccine has some sort of nasty long-term effect, like giving you cancer 10 years down the line, or causing your offspring to be born without limbs, it’s a lot less risky to give it to those with less of a long term to worry about. And while it’s taboo in risk-management terms to look at the other side of the equation, those over 65 will benefit more from a successful vaccine, so there’s compensation for that risk.

          For the test subjects you could trade off the better certainty of live-virus testing for the safety of measuring antibody levels, at least for some subset of your test subjects. But it _is_ a tradeoff.

        3. albatross11

          I’m assuming we’re hoping to actually stop this stuff circulating which would require probably >70% of the population to be immune. Also, younger people do get pretty sick with this stuff, and sometimes die of it. If you get a flu shot, you probably want a COVID-19 shot.

        4. albatross11

          Scoop:

          This is the CDC page on known vaccine safety issues.

          These are approved vaccines, and there are at least two instances of rare but serious side-effects that seem to have been linked to getting the vaccines. If all we have to worry about is rare-but-nasty side-effects, that’s probably worth accepting in exchange for getting the vaccine into widespread use.

          There were also some instances of comtaminants being found in vaccines–I think that’s mostly a manufacturing issue, but I could be wrong.

          I know there have also been vaccine trials that stopped because of detected problems–in some cases, the proposed vaccine is associated with worse illness or higher probability of catching the thing you’re vaccinating against. (I think this happened to a high-profile HIV vaccine candidate, discussed here.)

        5. albatross11

          The Nybbler:

          Since that’s open-ended (“as much assurance as possible”), it translates to not relaxing procedures in the slightest.

          No, it means that we still care about not making a bunch of people sick with our rushed-through-the-process vaccine, even though this is a serious crisis that is causing a lot of pain and suffering in the world. I’m not saying “let’s make safety the only concern,” I’m saying “let’s make sure we don’t unnecessarily accept a bunch of extra risks in the interests of moving as fast as possible.”

          There’s a painful tradeoff here, and there’s no perfect answer. I think we need to accept more risk of problems with the vaccine given the nature of the crisis, but that we still need to do what we can to avoid making people sick with a vaccine we plan to give to hundreds of millions of people.

        6. Edward Scizorhands

          We aren’t worrying about “10 years later there are bad side-effects.”

          The lowest risk method is to test in young people — even aggressively, with human challenge — and then do rollouts in young people. And as we start doing the rollouts in young people, we start testing in middle-aged people.

        7. albatross11

          I think you usually measure how protective the vaccine is early on by measuring antibody titers, and you can have good antibody titers but the vaccine either doesn’t protect you or makes you sicker. (A recent TWIV guest pointed out that antibody titers are a “correlate of immunity”–the higher the better, but that may or may not be providing the immunity in any given case, and for some diseases, it’s probably the cellular immune response rather than the antibody response that’s important.)

    4. Edward Scizorhands

      We could have the 25-or-so credible vaccine candidates fully tested in two or three months.

      What do you mean by “fully tested”?

      Do you think deliberate infection after immunization is going to cut 9-15 months off the schedule?

      1. albatross11

        That will cut a lot of time off the schedule, because we find out right away whether or not the vaccine is protective, rather than waiting several months and then checking to see whether the control group got the disease more often than the treatment group.

        1. Edward Scizorhands

          Does that part really take 9-15 months off the schedule? Does using human challenge get us a “fully-tested” vaccine in 3 months?

    5. tokugawa

      “We are at best 12-18 months away from one of the many vaccine efforts getting widespread adoption.”

      12-18 months is the accelerated timeline for vaccine production.

      You might find a deep read of this to refine your vaccine schedule (or perhaps not)

      https://www.cell.com/immunity/pdf/S1074-7613(20)30120-5.pdf?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1074761320301205%3Fshowall%3Dtrue

      Some of my notes from this piece:

      – During the 2009 H1N1 influenza virus pandemic, vaccine producers switched their production pipelines quickly from producing trivalent seasonal influenza virus vaccines to monovalent pandemic vaccines. This was basically just a change of strains and established and approved processes, established release criteria, and existing correlates of protection could be used (Krammer and Palese, 2015). **Still, it took six months until the vaccine was ready to be distributed and used**, and it came too late to affect the second pandemic wave, which took place in the United States in fall 2009. ^^This time, we are facing a new challenge in the form of a virus that has just emerged in humans, and the response will be more complex because there are no existing vaccines or production processes for coronavirus vaccines.^^
      – Finally, it takes time to distribute vaccines and administer them. To vaccinate a large proportion of the population would likely take weeks. Given that the population is currently naive to SARS-CoV2, it is highly likely that more than one dose of the vaccine will be needed. **Prime-boost vaccination regimens are typically used in such cases, and the two vaccinations are usually spaced 3–4 weeks apart.** It is likely that protective immunity will be achieved only 1–2 weeks after the second vaccination. This therefore adds another 1–2 months to the timeline. Even if shortcuts for several of the steps mentioned earlier can be found, it is unlikely that a vaccine would be available earlier than 6 months after the initiation of clinical trials. ^^Realistically, SARS-CoV-2 vaccines will not be available for another 12–18 months.^^

      1. albatross11

        Scoop:

        I don’t know where they are in the process, but I think it’s pretty important to determine the effective dose (and whether you need a booster) to ensure you get immunity, along with doing a small test first to make sure you don’t get some terrible f–kup that makes your subjects sick because of contamination or something.

        Once they’ve got that, I’d like to see them push forward to widespread testing really quickly. I bet they’d find a lot of high- and moderate-risk people who’d be willing to try the most promising vaccine candidate. I think most trials try to avoid people with underlying health issues, but for this one, I’d sure be interested.

        For myself, I figure it’s probably about 1% that I die if I get the virus, and probably about 50% that I catch it in the next year or two if we don’t keep the spread under control. (There’s almost no chance I’ll catch it during the lockdown.) So let’s say this is a half a percent probability (0.005) of me dying in the next year. Let’s spitball and say that by the time they’re willing to give a largish number of people an experimental vaccine, it’s at least 50% probability that the thing will provide lasting immunity. As long a the probability that it will kill me itself is less than 0.0025, this is a win for me. (There’s also a comparable calculation with serious illness/disability, but again, that goes both ways–even if you survive a 2-week stint in the ICU with coronavirus, you’re likely to have some lasting effects from that, and they’re probably way worse than anything i’d expect with, say, a subunit vaccine.)

        Having a set of young, healthy volunteers get the vaccine and then be intentionally exposed to the virus 3 weeks later would get us fast data on whether or not the vaccine was really protective, at least short-term. That would also change my calculations some, toward being more willing to be an early adopter. OTOH, if we’re likely to get the pandemic under control and my probability of catching it is only 10%, then I’m less excited about that.

      2. Garrett

        > Finally, it takes time to distribute vaccines and administer them. To vaccinate a large proportion of the population would likely take weeks.

        The people at high risk for transmission can be vaccinated quickly because we know who these are: all of the front-line workers everybody is currently praising such as healthcare workers, retail store employees, etc.

        And vaccinating the public can be done a lot faster than you might imagine. There’s already a CDC mechanism in place to deal with this: the Point of Dispensing. My ambulance service just went through the required training so that we can be part of a system to do this.

        For the public we’d likely end up running a multi-lane drive-through dispensing system. Load your family up into your car and come down to the mall/mega-mart/fairgrounds/whatever and go through the paperwork and get vaccinated, all from the comfort of your own car. With locations reasonably set up (according to system goals) it can be done in a matter of a handful of days. (I’m not in an urban area so I don’t know how things are likely to be handled there, but the same throughput goals exist.)

        Our county seems to be well-prepared for this, but not all counties in our region are at the moment. Hopefully folks across the country will know about this and get on-board.

    6. Douglas Knight

      We don’t need challenge trials. Just vaccinate nurses. The data will come in fast enough.

  15. skyclear100

    Am I the only one who still needs to go to the office to work during covid-19? I stopped taking public transportation a long time ago as soon as the virus hit New York. It has been really bad. New York is the epicenter of the world. The US gov is doing a bad job compared to East Asian countries regarding the virus. Right now, I wear a mask, get on my scooter (if you want to avoid transportation, here is a link for the scooter I got), and go to work for that BREAD!! Ahhh

    1. Garrett

      I go in for my scheduled shifts volunteering on the ambulance. Of course, with call volume dropping there’s been less of an urgency to staff to full levels and less overtime available so fewer people are calling off, meaning there are fewer shifts I can pick up. But EMS is one of those things that you can’t do remotely. My full-time gig has me working from home.

  16. DNM

    I know a low-risk 20-something who has been furloughed for 4 weeks now. Living off savings for now. Some roommate troubles. Feeling useless, stuck in a Groundhog Day scenario. Reasonably technically adept but not in bio or any other directly-useful field. What is the best way this person can contribute to society at this point? Are there useful volunteer gigs that can be done from home by those with plenty of available time? Is it worth trying to convince the roommate to ok food bank volunteering or grocery runs for those who need it?

    1. noyann

      Offer video conversations to someone abroad learning your language. Just talk and correct mistakes. Or learn him/herself that way.

  17. Nancy Lebovitz

    Is it appropriate to talk about the coronavirus on the Open Thread? I have a notion that pandemics could be part of the great filter.

    1. albatross11

      Nancy:

      I’d worry more about engineered ones than natural ones. But in general, it seems like it’s not so hard for a society to be arranged in such a way that pandemics won’t infect everyone. I mean, we’re at a point where engineered plagues are definitely possible, but also where we can detect them pretty quickly and could set up isolated colonies or other places where it would be very hard for the plague to reach. If even 5% of civilizations do that then I think pandemics don’t work as a great filter because they miss 1/20 of the societies that reach that point.

      OTOH, maybe engineered plagues can be designed to get around those defenses somehow. (Someone makes a plague that is carried by more-or-less every bird and insect on Earth and it infects even our carefully-isolated pandemic survival colonies.)

      1. Nancy Lebovitz

        What I’m thinking is that maybe you need a lot of travel and contact to get to a sufficient tech level to get off a planet, and that natural plagues are an ongoing risk.

        When you say colonies, do you mean off-planet colonies?

        Isaac Arthur has the plausible notion that maybe it isn’t a great filter, it’s enough medium-sized filters which add up to make the stats unfavorable.

  18. carton

    the part I like is the discussion of the phrase “follow the pandemic response playbook”

    This was also the part I liked best, but it still spiralled rapidly to standard TDS. A good alternate-universe argument that starts with assuming Hillary would have followed the Pandemic Playbook perfectly would have to connect two things with cause and effect:

    – cause: a specific way that Trump’s team didn’t follow the playbook.
    – effect: a negative outcome in handling the pandemic.

    The N95 mask sneering wasn’t specific, and he has no negative outcome to point to. The expected negative outcome would be “hospitals don’t have capacity because doctors and nurses are sick,” which happened in Italy and is accounted for in the more nuanced curve-flattening models, but which hasn’t happened here yet. If he thinks it’s going to happen he ought to make the full wager, not get non-quantitatively sentimental about “front line workers” in the “war” being entitled to “more respect than orangeman’s other crazy tweet I have here,” and so on, as I imagine he would do from what he’s written so far, if he were pressed on this point.

    I think it’s important to realise that the President’s scope is larger than the scope of the people who wrote the Pandemic Playbook, so in an ideal world I wouldn’t want to elect a simple playbook follower unless the alternative were really bad.

    But we aren’t even to the point of making that judgement when the critic on tumblr has no negative effect to point to.

    Thanks for linking to the actual playbook!

  19. mlicinius

    Some thoughts on the mail voting issue from a political consultant who primarily works in heavily vote-by-mail western states:
    1) There’s no particular evidence of a partisan advantage to universal VBM. Colorado saw it slightly help Republicans when it was implemented, Utah saw it slightly help Democrats. In California, vote-by-mail votes are consistently substantially redder than poll votes. A number of CA Counties got universal mail ballots in this March primary for the first time, and again we didn’t see noticeably bluer turnout than would be otherwise expected in those counties.
    2) I don’t think there’s a big risk of a big implementation fiasco with vote by mail. Over a quarter of all ballots in the country are already cast by mail. 5 states do exclusively universal VBM for everything. California is not universal VBM but we send out more VBM ballots than there are voters in any other state. Most states have no excuse absentee voting. Scaling up vote-by-mail from 0% to 25% of the electorate seems like it would have been the place where there’d be implementation issues, rather than scaling up from 25% to 100% – once you’re already mailing ballots to tens of millions of people and mailing out at least some in every state you’ve probably worked out most of the kinks. Now there will almost certainly be small implementation fiascos – every election some county registrar somewhere in the country is going to screw up – but that’s going to happen regardless of the election system.
    3) Perhaps the more Bush v. Gore part of universal VBM is the idea that the presidential election would not be decided on election night. Western states often spend weeks after the election counting mail ballots, and one could easily imagine a situation where candidate A is leading in the electoral college at the end of election night, gets declared the winner by the AP, and then loses the lead due to late VBMs. This is a process that anybody who has worked in western states politics would be used to, but one could imagine it causing a bit of chaos the first time it happens.

    1. albatross11

      How hard do you think it would be for jurisdictions that currently count on in-person voting on voting machines to switch over to mail-in ballots? My non-expert impression is that they’d need to be working on that transition now to have a chance of it going smoothly, because they won’t have either machinery (optical ballot scanners) or people set up to handle all the mail-in ballots they’ll get.

      1. HeelBearCub

        Some of that depends on their existing ballot counting approach. If you have optical scan equipment at the precinct level, you already have sufficient equipment. Scaling the mail-in absentee process is probably more of an issue.

        According to this Pew article from 2016, only 28% of voters are in DRE only jurisdictions. 48% in optical scan only, 19% mixed. 5% are already mail in only, and the rest seem to hand count paper ballots (i.e. very low population precincts).

  20. eric23

    Re bats:
    The theory I heard is that as bats have high temperatures due to their flying, any bat virus has evolved to be somewhat immune to high temperatures, which makes fevers less useful as a tool of the human immune system to defeat viruses.

    Re Brazil:
    Supposedly there has been a behind-the-scenes coup and the coronavirus-denying president only remains as a figurehead without power.

  21. Purplehermann

    The economists are using extremely naive models.

    The VLS is based on what people are willing to pay for a chance reduction of their death, on average (or something along those lines).

    The virus is mostly killing unhealthy and old people.
    People with no underlying conditions very, very rarely die from this.
    (Not that there won’t be a terrible amount of life lost from the young healthy demographic).

    A lot of these people don’t work. A lot of resourses are spent on them.

    Measuring the economic situation based on an assumption that economically all lives are equal is ridiculous.
    An 80-year old with multiple health conditions is not worth $10,000,000 to the economy I would think.

    There could even be a net benefit economically to letting the virus rage and prioritizing younger, healthier people in care, the elderly and infirm being culled could make life a lot easier for the economy. The work has to be shown there isn’t.

    [Edit:the expert panel seems to be answering questions about the actual corona policy, not saying what should be done from a purely economic perspective, basing their answers on the study, or saying the fear of coronavirus will probably damage the economy anyway even if restrictions are released. Only the last reason merits discussion in the context of “is it worth it economically?” The panel can otherwise be pretty much ignored.]

    1. eric23

      Discounting the lives of old people is akin to randomly choosing young people to kill for organ harvesting. It’s justified from a naive utilitarian perspective, but loses its benefits once you take into account the indirect social effects as people modify their choices to accommodate it.

      1. Purplehermann

        @eric23 could you explain a bit more? I don’t really get your reasoning.

        How are these people worth $10M to the economy? Why are they worth the same as young healthy workers?

        1. albatross11

          Quite a few people who die or get very sick from this virus were still leading economically productive lives–think a 60 year old CEO or senior scientist or electrician or high school teacher with diabetes and high blood pressure. In the US, I think a majority of people in their 60s have at least one existing medical condition. It’s not a disease that only kills 90-year old dementia patients.

          FWIW, I’m an overweight asthmatic in my 50s, and I’m at substantial risk (I’m guessing around 1%) of dying or at least getting very ill and ending up in the hospital for a long time if I catch it, based on the available statistics. And yet, I’m still in a very productive part of my career. Nor am I all that unusual–there are a lot of people in their 50s and 60s still working and still doing high-value work, and even some in their 70s. And I don’t think I’m just engaging in special pleading when I say that the US will not, in fact, benefit economically from getting rid of 1% of people like me, or 2-3% of people 15 years older than I am.

          Now, that doesn’t tell us whether the lockdown is worth it, or what measures would be worthwhile. But if you propose letting the virus run wild, you should probably try to estimate the economic impact realistically, which means people still having productive careers dying or ending up permanently disabled.

          Another part of that impact will be that people like me move heaven and earth to avoid catching something with a 1% fatality rate for us, which means that even if you end the lockdown tomorrow, there’s a lot of economic activity I won’t be engaging in until the people offering it to me convince me I’m very unlikely to catch the virus by doing it, from going to get a professional haircut to going to the movies to flying to Europe. This will be a lot better for me than most people, because I can work 100% from home if I need to, my job doesn’t require me to interact with the public day-to-day, and I live somewhere that’s going to continue to offer delivery or curb-side pickup for groceries and such. That part of the economic impact won’t go away even if Trump and every governor calls a halt to all the lockdowns tomorrow.

          1. Purplehermann

            @albatross11

            It looks like most of the people dying are past retirement age.

            There are definitely people who are economic drains dying.
            There are also people dying who are economic plusses, but likely less of them.

            Using $10M for every life from an economic standpoint here is naive. (Yours is worth more than a 90 year old dementia patient’s for example.)

            To make a claim that economically it’s better to stay closed, these factors would have to be taken into account.

            There are definitely tons of factors, and I really don’t know.

            Personally, the idea of letting it run seems horrible. The paper just seems really off to me.

            Also, your risk rate is probably a good bit higher than 1%, good to know you’re keeping safe.

        2. DavidFriedman

          How are these people worth $10M to the economy?

          “To the economy” isn’t the right way to think about it. My life is worth quite a lot to me, whether or not other people profit by my existence.

          1. LesHapablap

            The study accounts for economic effects of all the extra deaths by using -2% GDP for 2020 (from a baseline of +2% GDP):

            In the uncontrolled scenario (without social distancing), we assume an immediate shock in GDP of -2.0%, due to the large number of excess deaths, loss of productivity due to sick days, and the inordinate strain on the health care system during the span of the outbreak.

            If they are estimating economic effects only, they should not be including the 10MM per person.

            We find out how much it costs first, and then we decide if it is worth the economic hit for the lives saved. To do otherwise is dishonest.

            me: “Hello my spouse, there’s a sale on motorcycles! They only cost -$5,000! They literally paid me to take it away!”
            -month later-
            wife: “Our credit card statement says the motorcycle cost us $7,000.”
            me: “Yes but I get $12,000 worth of value from it!”
            wife: “…”

          2. DavidFriedman

            If they are estimating economic effects only, they should not be including the 10MM per person.

            I think your definition of “economic effects” is narrower than mine.

          3. LesHapablap

            Your definition is not the one that people are interpreting that study with. They are looking at that study and assuming that the economy (that is, jobs, GDP etc) will be much better off (5 Trillion) with lockdowns than without.

        3. eric23

          If we lived in a world where people were randomly kidnapped and killed for their organs, it would be a very different world. Anyone who could afford it would pay for massive amounts of security to defend themselves against kidnappers. Everyone would be extremely suspicious of outsiders who might be involved in a potential kidnapping. Few people would give their medical details at the doctor lest this be used to categorize them as good kidnapping targets. The social and economic cost of these measures would lead to a large number of deaths, likely outweighing the lives saved by organ transplants, and decreasing the enjoyment and quality of life for everyone.

          I think a similar thing would happen if it became accepted that lives are more discardable after retirement age. Depression among the elderly would skyrocket. People would have fewer kids and invest less in those kids, knowing the kids would not invest in them. Young people too would feel they were only valuable as a paycheck; their anxiety levels would rise and their sense of purpose plummet. Etc. These detrimental social effects would cause much more harm than the savings from not paying for medical care for old people.

          1. albatross11

            Also, it’s hard to imagine that kind of decision being made at a political level, given that older people vote pretty regularly.

          2. Purplehermann

            *Accidentally reported, nothing wrong*

            1. Economically the elderly are generally worth less, this is reality as far as I know.

            2. As for a Schelling point or thing we agree to do so society can function, making pandemics an exception should take care of that

          3. DavidFriedman

            I think a similar thing would happen if it became accepted that lives are more discardable after retirement age.

            I may be misreading you, but is your argument of the form “Statement X is true, but we should pretend it is false, because believing it would have bad effects”?

            Or do you really believe that what is left of a person’s life at age ninety is of the same value as what was left of that person’s life at fifteen?

    2. keaswaran

      “An 80-year old with multiple health conditions is not worth $10,000,000 to the economy I would think.”

      That is plausible. $10 million is said to be the value of the life of an average adult, so presumably an 80 year old with multiple health conditions would have lower value of the rest of their life.

      “There could even be a net benefit economically to letting the virus rage and prioritizing younger, healthier people in care, the elderly and infirm being culled could make life a lot easier for the economy.”

      This doesn’t make sense. If someone isn’t actively trying to kill themself, then their death *is* an economic harm. I suppose it’s possible that health policy is so bad that the resources we expect to spend in the last few years of life are greater even than the value of the life before those resources are spent, so that we could on net gain value by killing the person now. But we would gain more value by not killing the person now, and just not spending the resources later.

      The economic value of life is not the value that someone’s life adds to GDP. GDP is only an approximate measure of economic value. GDP is a measure of the dollar value of things that are valued on the marketplace. Economic value is the sum of *all* value that people care about, with GDP being an approximation to it. The value of a statistical life is about trying to measure this value from the observed payments people make for safety improvements. At minimum, something like this, as well as the value of childcare and housework done uncompensated, should be added to GDP, just the way that “imputed rent” is used to measure the value of a house to a homeowner.

      1. DavidFriedman

        At minimum, something like this, as well as the value of childcare and housework done uncompensated, should be added to GDP

        You may be remembering Alfred Marshall’s point that, when a man marries his housekeeper, national income goes down.

  22. Purplehermann

    The R0 of covid19 being 2.4 seems ridiculous to me.
    The number is apparently based of early Chinese data.
    SARS had an R0 of ~3.
    MERS was higher.
    Could someone explain what I’m missing?

    1. eric23

      COVID19 spreads more before people are symptomatic. So awareness of its existence is not enough to reduce R0.

      1. Radu Floricica

        It seems to spread (quite a lot) in hospitals, so even after people should be aware that it’s there. This suggests it’s not just that.

        @Purplehermann In itself, an R0 of 3 is not big. Measles is over 10.

        And there’s probably the anthropic principle at work as well. There might have been quite a few coronaviruses transmitted to humans, but if they had an R0 under 1, we never knew them. Those we do know aren’t in numbers large enough to be able to say if there’s a pattern. But as a quick sanity check, it seems to be about as easy to transmit as common cold, especially if we consider half the cases are asymptomatic there as well.

        1. Purplehermann

          The numbers are for comparison.

          It seems odd to me that both mers and sars would have higher R0s than covid 19, while spreading way less

          1. Radu Floricica

            Ah, sorry. I read it the other way around. In this case, the answer is pretty simple: the numbers I hear put 2.4 at the lower bound. It could be anything between 2.4 and 4, depending on strain, cultural context and many other factors.

            This plus delayed and much less serious symptoms probably explain the difference. Also many serious cases still start as a moderate to bad flu, until the collapse around the 10th day of symptoms – so that’s an extra 10 days to infect people that just treat is as regular flu.

          2. HeelBearCub

            @Radu Floricica:
            I believe, all things being equal, having more time to infect people, should just raise R0.

            If I had to guess, that might mean Covid-19 is general harder to spread, but has more time to do so. Which should mean spread isn’t as localized.

          3. albatross11

            R_0 is a function of both the virus and the environment (including human behavior). SARS seemed to have very little transmission by people who weren’t visibly sick, which made quarantine measures a lot easier to implement, and meant that you could quickly drive R_0 way down. Fever checks and sending anyone who was the least bit sick home from work or school could accomplish a lot there.

            SARS2 seems to have a fair bit of spread before the patient gets sick, and many patients never do seem to get very sick–they have a cold, but nothing like the young, healthy folks describing it as “the worst flu I’ve ever had in my life,” let alone the ones who end up dying of pneumonia. That makes it a lot harder to quarantine or avoid the sick people to stop the spread.

      2. John Schilling

        COVID19 spreads more before people are symptomatic

        Citation needed. COVID-19 can spread before the carrier is symptomatic, but everything I have seen indicates that it is less likely to spread than with a symptomatic carrier and represents a minority of overall transmission.

        1. noyann

          From here:

          Specifically, our approaches suggest that between a third and a half of transmissions occur from pre-symptomatic individuals. This is in line with estimates of 48% of transmission being pre-symptomatic in Singapore and 62% in Tianjin, China (30), and 44% in transmission pairs from various countries (31). Our infectiousness model suggests that the total contribution to R0 from pre-symptomatics is 0.9 (0.2 – 1.1), almost enough to sustain an epidemic on its own.

          But see the paper for the model, its uncertainties and underlying assumptions.

          1. John Schilling

            There’s nothing fundamentally wrong with the paper that I can see, though of course I am not an epidemiologist. But, 48% of transmission being presymptomatic implies 52% being postsymptomatic, and 48% is not more than 52%. And, this is one study at the extreme high end of the range I’ve see. For example, this research letter published by the CDC claims 12.5%. Here is one suggesting 25%, based on WHO results from China. One from Singapore, suggesting 6%. Most reporting, e.g. the latest WHO Sitrep to address the issue, doesn’t try to put an exact number on it but indicates that presymptomatic transmission represents a small fraction of the total.

            I haven’t seen anyone indicate that a majority of the transmission is presymptomatic, and even calling it a large minority is a contrarian position with little support.

          2. albatross11

            That number is heavily affected by human behavior. If nobody knows about SARS2 yet, then symptomatic patients are a lot more likely to spread the disease, because people won’t be trying to avoid sick people so much. Once everyone knows about SARS2, every employer has told their employees to stay home if they’re sick, and going out in public coughing and sneezing means everyone shuns you and is mad at you, then asymptomatic transmission is going to become a larger fraction of the total, just because there will be less symptomatic transmission.

  23. Guy in TN

    Some socialists on social media are trying to spread a narrative where capitalists think the economy is more important than lives and want to lift the lockdown immediately, and it’s only socialists who are standing up for the importance of saving people. Top economists aren’t a perfect stand-in for capitalists, but it’s still pretty clear that they’re wrong.

    This is a weaselly-worded paragraph.

    You’ve got two claims here:
    1. The left says capitalists think the economy is more important than lives
    2. The left says capitalists want to lift the lockdown immediately

    You provide solid evidence that a group of capitalist economists believe that lifting the shutdown would hurt the economy. And therefore, you suggest that capitalists do not want to lift the lockdown.

    But the thing is, this is entirely consistent behavior for someone who values the economy over human lives. Of course someone who values profit over human life would choose to save human lives if it increased his profits. This means nothing! If you have a scenario where maximizing profit and saving human lives require the same course of action, then asking people what they would choose to do provides no evidence one way or another.

    So you say the left is “wrong” about this. But you’ve only provided evidence that they are wrong about the trivial claim (“capitalists want to lift the lockdown immediately”), but they could very well be right about the more fundamental claim (“capitalists think the economy is more important than lives”).

    1. Guy in TN

      …they pretty unanimously support the lockdown, even when asked only to reflect on its economic impact.

      Also, as an aside, I just want to point out that your jump from the descriptive to the normative here (“Economists say the lockdown helps the economy”->”Economists support the lockdown”) bolsters my long-running argument that “economics”, in shorthand popular conception, has ceased to be a scientific tool for understanding descriptive reality, and is instead largely a philosophical project for advancing normative political goals.

    2. Purplehermann

      I would read the panel, it nearly reads as “lives more important than economy”, the question scott brings looks to have been (generally) interpreted as meaning multiple lockdowns because it wasn’t done right the first time would be worse than just leaving it.

      Seriously, read it.

  24. MisterA

    On the question of tracking total deaths from any cause vs. deaths attributed to COVID-19, the NY Times has preliminary numbers from the CDC on total monthly deaths, compared to historical data. And the results are pretty bad – the number of deaths is far higher than both a normal month, and than the official count from the virus. It is also expected to go up, as not all deaths from the past month are counted yet.

    https://www.nytimes.com/interactive/2020/04/10/upshot/coronavirus-deaths-new-york-city.html

    1. albatross11

      Yeah, this could be any of:

      a. False negatives with the tests. I think they’re doing nasal swabs for the tests, and those are apparently easy to mess up.

      b. Reinfection, which suggests that maybe immunity isn’t all that long-lasting for COVID-19. If immunity wanes after a couple months, containing this crap is going to be very hard.

      c. Resurgence–maybe the virus can hang out in some cells as a latent infection and reawaken later on. But then we need to know why the patient’s immune response didn’t clobber it–were all 91 of those patients immunosuppressed somehow? Probably not or they would have mentioned that in the story. But maybe the patient’s immune response keeps the virus from making the patient sick, but they’ve still got some virus and could maybe shed it in some circumstances.

      1. HeelBearCub

        a-2: False positives. Not sure how likely that is here, and I would assume that these are still positive on retest, but I don’t see it mentioned. It’s just worth considering given that even a very small chance will pop up lots of time when you repeat the test enough times.

        1. Clutzy

          Indeed, this is why I have been telling people to stop thinking testing fixes things. When you test such a large % of the population your false positives will be sufficiently numerous to confound all your efforts (and the false negatives are even more likely to be perilous). Some estimates I’ve seen have the S Korean tests at 5% false positive and 25%+ false negative. This is an expected result.

          1. HeelBearCub

            Mmm, I think this is wrong. Plans based on an assumption of perfect testing will fail. Plans based on reasonably accurate assumption of false testing rates can still succeed, especially if are knowledge about R0 is also reasonably accurate.

            If R0 is actually much higher than we think it is, insufficiently accurate tests won’t be able to stop it spreading. Good news though, that would mean far more people are already infected, and the disease isn’t nearly as deadly as we currently think it is, rendering testing sort of a moot question.

          2. Clutzy

            Possibly, but there is also the chance of a high R0, but the voluntary social distancing followed a week or so later by government lockdowns made its R0 outside of pockets never really get high. This is kind of the worst case because it would mean that there were not enough infections for many ppl to have immunity, but it also easily spreads in places like buses, supermarkets, etc where it will stay alive then it explodes back up in a way that is untraceable for most efforts, particularly in big cities.

            This is the worst case because it means we are going to get death no matter what, and we have shutdown destruction, and we have probably a 2nd shutdown destruction.

            Also there is another problem for the “flatten the curve” idea: Medical intervention is not very effective against C19. We don’t need more ICU beds for them, we need separate C19 hospitals (aka a bunch of beds in a stadium pf gymnasium) because the biggest problem is them infecting other hospital patients. Most of what we can do for them is push IV fluids

        2. fallenscien

          False negatives are way more common that false positives for PCR-based tests, which are what is being used to identify current infections.

          False positives should pretty much only happen due to operator error or cross-contamination. So they should be very near zero. As FiveThirtyEight points out, the total rate of positive tests among asymptomatic individuals in Iceland is less than 1%, which means the false positive rate must be less than 1% (and probably quite a bit less).

          False negatives are rampant in PCR-based testing. A 25% false negative rate is reasonable. It’s the right ballpark, at least.

          False positive rates for serological tests, on the other hand…

          1. keaswaran

            Could the false positive rate be different in people who recently got over an infection though? It seems quite plausible that some bits of viral RNA might stick around even after the virus is no longer actively infecting any cells, and this might show up in tests.

      2. fallenscien

        I’d guess b or c is the most likely.

        This virus’s spike protein is almost completely covered in glycans, and needs modification by a host protease (furin / TMPRSS2) before the receptor-binding domain is optimally exposed. So I expect it to be damned near invisible to the host immune system before modification.

        ACE2 receptors are also all over, but most prominent in the respiratory system and small intestine. So there are plenty of places for low levels of the virus to hang out for a while, then eventually make their way back into an area with higher ACE2 density.

        Given that the virus has been detected in cerebrospinal fluid, it can clearly find its way into some weird places.

    1. Edward Scizorhands

      He’s arguing for deliberate infection with a mostly-harmless strain.

      As someone who has been arguing that deliberate infection should be in our repertoire (even if not necessarily used) it seems that the problem of finding and testing a mostly-harmless strain is similar to finding and testing a vaccine. And we already have several vaccine candidates ready to go through testing.

    2. Lambert

      It’s just a variolation on a common theme.

      I see no reason why finding one of these benign strains should be any faster or easier than making a bunch of spike protein mRNA,

  25. dorone

    Great posts, as usual.

    I have been thinking what is the best metric for understanding the COVID-19 situation in a country (or state).
    1) Reported cases is clearly not a good indicator. It is lagging, and highly correlated with the number of tests performed. An increase in the number of tests may cause more reported cases, and visa-versa.
    2) Deaths by itself is also not a good indicator, as that just may indicate that the health system has collapsed (as seems to have happened in North Italy for example).

    So I would like to suggest looking at the number of people in Critical Condition as an indicator. That too may be off because of the health care system has collapsed, then people in Critical Condition will die more often. Then we need to add Deaths to the number of people in Critical Condition as an indicator. I understand that this metric too may be skewed as doctors will be harsher in categorizing people in critical condition the more load they see (classical Triage)

    Based on this metric, we can even build a model which predicts how many deaths in a country based on time and people in critical condition. Perhaps also factor in number of people that were in Critical Condition and got better. As a basis for the model, we can take countries where we know the health system did not collapse – such as South Korea, Singapore, Germany and Israel.

    I also think that using this measure, we can estimate how many people are actually infected, at least more accurately than active cases alone.

  26. johan_larson

    Anyone here seeing real shortages at their local store?

    I went shopping this morning, and the store seemed well stocked. In some cases the goods available have shifted a bit. I couldn’t find my favorite types of sausage and cheese, but there were many other kinds. For some staples, like rice, they’ve started selling much larger sizes.

    1. The Nybbler

      I don’t know; I can’t go to the store because after requesting that people donate masks to first responders, the governor is now requiring masks to go to stores. And I can do a lot of things, but sewing a face mask that will actually stay on my face from expedient materials is not among them.

        1. Radu Floricica

          To protect yourself, they’re not really good for much, but to protect others they’re ok. Here counties started deciding to require masks, and it’s specifically mentioned that if you don’t have masks, scarves or something similar is ok.

    2. Radu Floricica

      In Bucharest people are stocking for Easter. No shortages whatsoever, even masks are back in stock ($2 a piece at the pharmacy, around 60c online in boxes of 50). No respirators yet, n95 or over, I guess those are harder to manufacture and more requested by hospitals.

    3. beleester

      Not severe shortages, aside from the obvious panic staples. Eggs and milk are limited to 2 items per customer, toilet paper is almost nonexistent (seems to have finally returned to the shelves 3 weeks after the shutdown started) and if you want pasta, rice, or other grains you’re probably out of luck (but I did find a few). But in general, I didn’t have trouble finding what I needed, I just had to buy a slightly more expensive brand than usual.

      There have also been a few oddly specific shortages – tofu, for one – which I doubt are the result of panic, so it’s possible some smaller suppliers are shut down or delayed due to the virus.

      1. keaswaran

        Tofu is one of the shortages I and several other friends in other states have noticed as well. It’s one that I don’t have an explanation for, unlike the other shortages I’ve noted at various points in the last few weeks, like flour, hand sanitizer, toilet paper, garlic, and onions.

        1. Edward Scizorhands

          I was thinking of getting some tofu to substitute for lack of meat choices. (I since got a separate supply of chicken.) This may have driven some other people’s buying choices.

    4. John Schilling

      Have been shopping perhaps a dozen times since this began, most recently a few days ago. On one instance, there were about half a dozen four-packs of toilet paper remaining on the shelves of one of the stores, and I took two. In literally every other case, the shelves were utterly bare of both toilet paper and paper towels. That shortage was both rapid and persistent.

      Bulk bread and potatoes came back into stock at least intermittently about two weeks ago; specialty bread products like hot dog buns and english muffins were available for a while before that. I haven’t seen bulk rice yet, but have mostly stopped looking.

    5. Edward Scizorhands

      Things that people can store long-term are often in short-supply, presumably from hoarding. Things with a limited shelf-life are generally there.

      Rice: completely gone.

      Boxed prunes: nearly gone. I noticed this because I added prunes to my diet several months ago, and they are very shelf-stable so I packed a canister into my prep kit ~2 months ago. I made sure to pick up a new container each time, and they were down to only a few left last time. Sad me but I reduced my daily allotment accordingly.

      Apples: Mostly left are the organic varieties now, so yay price discrimination.

      Bananas: No problem getting as many as I want, but the shelves are about half-full of what I would expect.

      Milk: Readily available, although not the precise kinds I normally prefer.

      Cottage cheese: went totally missing for a while, then back in limited varieties. Now seems to be coming back in all varieties.

      Avocados: Plentiful.

      Bread: Available in what I need, but they limit me to 2. Okay.

      Cereal: Full shelves.

      Pop-Tars: Nearly full shelves. I honestly thought these would be hoarded but maybe they are just so dense that people got whatever they wanted.

      Microwave Popcorn: Limited amounts on shelves, and my kids have been eating a lot of it.

      Paper products: I haven’t even bothered to look.

    6. Lambert

      The worst of it seems to be over here.
      Stuff like staples and tinned tomatoes are reappearing on shelves.
      Still no flour or eggs.

    7. Loriot

      The store seemed to be mostly stocked the last time I went, but I didn’t look closely since I was trying to get in an out as fast as possible, and that trip was also right after opening, so outages would be less likely a-priori anyway. The previous few trips, I’d noticed that among other things, they were completely out of toilet paper, sanitizer and the like, and I expect that aisle is still empty.

      The impression I get is that you don’t have to worry about running out of food, though it’s best to arrive really early if you want specific things like eggs or oatmeal. But sanitizer is another matter entirely.

    8. anonymousskimmer

      I see paper goods shortages in typical grocery stores, but my local Target was fine for paper goods last Monday when I went in the morning (as long as you like P&G towels and toilet paper, which I do).

      Try going to larger stores that have their own large-scale distribution networks.

  27. An Fírinne

    >Some socialists on social media are trying to spread a narrative where capitalists think the economy is more important than lives and want to lift the lockdown immediately, and it’s only socialists who are standing up for the importance of saving people. Top economists aren’t a perfect stand-in for capitalists, but it’s still pretty clear that they’re wrong.

    I’m an actual socialist (not a Berniecrat) who is active enough in leftist social media and I have not seen a single individual make that argument. Seems like you’re just misrepresenting them.

    1. DaveK

      I believe what they are referring to is people who (often conservative) express concerns about the lockdown based on economic consequences or suggest the need to lift the lockdowns on the basis that the economic consequences would be more harmful then the virus unchecked.

      There was one elderly senator some weeks ago who expressed a sentiment on foxnews about old people needing to think about the future of the republic and he mentioned economics. This got memed as “republican senator says old people need to die to protect the economy for young people” and widely mocked.

      I think that characterization of his comments was a bit unfair. I believe he was responding to the initial Imperial School of London report that suggested and 18 month lockdown was necessary and lockdown might have to become a permanent state of affairs, with full lockdown half the year and the government lifting restrictions at time based on hospital capacity. That latter scenario was based on the possibility that the vaccine wouldn’t work.

      The senator in question didn’t just reference the economy but also talked about what the country would look like in terms of freedom.

      Trump also expressed concerns about the economy (“we have to be sure the cure isn’t worse then the disease”) and it has become something of of an anti-republican meme that supposedly many republicans are more concerned with their stock portfolio then people dying.

    2. Sniffnoy

      A particular commenter who is banned here, and who is obsessed with Marx and the exact text of Marx’s writings in particular, just made that claim over in the comments on Shtetl-Optimized:

      Because what capitalists want and what scientists want are two different things. Politics is about manoeuvring between different groups like this, and if you’re going to please the scientists then you’re going to anger the capitalists in many cases. Just look at our current situation! Science says we should have all gone into isolation much earlier, but capitalist says we should all work as much as possible. Would you have been prepared to make the call “stay inside” a month earlier if that stock market line was gonna go down more sharply and for longer?

      So, yeah, it’s out there.

      (Note: This comment does not use that commenter’s name as it’s apparently on Scott’s list of words you’re not allowed to use in comments!)

  28. Exetali Do

    Long-time lurker here. I’m pretty sure I’ve gotten covid-19 and recovered. Going by the CDC website, I should be fine – it’s been almost 2 weeks since I first noticed the shortness of breath, and about 9 days since my fever broke. These days, it’s hard for me to search the Internet due to (non-military) PTSD (and the physical distancing has interrupted my EMDR treatment), and my intellectual capacity is still reduced from various medical treatments I had last year. And right now, every other set of people I’m in contact with seems to be panicking and providing conflicting unsourced information on what to do. So I’m hoping maybe y’all can help me, and I’m sorry for putting this on you, but I don’t know where else to ask.

    How safe am I to go outside my apartment? If I wash my bike off, will I leave deadly germs all over my apartment building’s hose? Should I try to get tested to confirm that this was covid-19, or are tests rare and valuable things that shouldn’t be wasted on me? (I’m in a city where it’s already a problem, so there’s probably no useful way to trace transmission to or from me.) If I restart volunteering at a soup kitchen, will that endanger people who have marginal health? Are there important things that I’m just not thinking of?

    Thanks…

    1. DaveK

      The first thing is, I think anybody giving you advice has to provide you with some very strong caveats. Specifically, I don’t think anybody would be confident enough in the specific advice they give you to give it to you in the first place, as lives could be at risk.

      That being said…
      “Should I try to get tested to confirm that this was covid-19, or are tests rare and valuable things that shouldn’t be wasted on me?” Since you have described the situation in your city as being such where there is a shortage of tests, the answer is probably no.
      However, as the antibody test becomes available, you could look into getting that depending on what your city is recommending (they may initially want to save them for frontline workers.)

      In terms of the time since your last symptoms, out of an abundance of caution you should probably assume that you may still be infectious for a week more.

      Generally the theory has been people continue to be infectious 8 days after they are symptom free, so giving it another week puts you in the safety margin.

      You very well may have had COVID and recovered, but I would not assume that, and untill you can be sure you should continue to take the precautions you would if you had never had it.

      “How safe am I to go outside my apartment?” If you haven’t had COVID, your risk factor depends on your age, pre-existing conditions, where you, live, what you do when you’re outside, etc.

      Staying inside as much as possible is the best way to reduce risk. When you do go out, maint social distance, wear a mask or other covering, wear gloves if you have them, and wash your hands when you get home.

      Outside areas are safer then inside areas, and generally the smaller the inside area, the higher the risk.

      “If I wash my bike off, will I leave deadly germs all over my apartment building’s hose?”

      I’m not sure I understand the question. Is our concern going outside, touching things, then touching the hose before you wash your hands and transferring germs onto them?

      If that’s what you mean, if you really want to be careful, you could wash you hands before touching the hose or wear gloves when touching it, but honestly I don’t think it’s something you need to concern yourself if that’s what you mean.

      You should also keep in mind not getting any exercise for extended periods of time can also have health consequences.

      If you would be comfortable sharing your age and medical history, I could give you a rough sense of your risk factor from contracting the virus.

      1. DaveK

        Also… Why would you be washing your bike with a hose? I would think that would cause the gears to rust.

        1. HeelBearCub

          That’s like saying you can’t ride your bike in the rain.

          Just provide proper maintenance and it should be fine.

        2. Exetali Do

          Because it’s been quite a while, so I want to get rid of all the spiders and other macro stuff, before I start going over the gears and chain with oil and a rag.

      2. albatross11

        The limited experimental evidence so far says that COVID-19 doesn’t survive all that long on surfaces. At room temperature, probably it’s no longer infectious after 3 days or so. (But it will probably survive a long time in your refrigerator or freezer, and longer than 3 days if it’s on a surface left outside and the outdoor temperature is, say, 40 F.

        1. Tatterdemalion

          I’m not saying you’re wrong, but I’d phrase this as

          “The limited experimental evidence so far says that COVID-19 survives for quite a long time on surfaces. At room temperature, it can still be infectious for up to three days”.

      3. Exetali Do

        The first thing is, I think anybody giving you advice has to provide you with some very strong caveats. Specifically, I don’t think anybody would be confident enough in the specific advice they give you to give it to you in the first place, as lives could be at risk.

        Well, yes. I’m not going to follow any advice robotically. But in general, I’d tend to give a higher degree of confidence to information I get here, than to panicky text messages from friends who also send panicky text messages about the latest developments in the Culture War. Like I said, most of what I’ve been seeing is unsourced and conflicting, so if you’ve got anything better than the CDC website, I’m all ears. (Like a bat.)

        I’m not so much looking for the basic advice, but more to see if anyone actually *knows*. I seem to have lost most of my instinct for self-preservation, so I’m having to wing this using what remains of my rational brain.

        I’m not sure I understand the question. Is our concern going outside, touching things, then touching the hose before you wash your hands and transferring germs onto them?

        More or less. A lot of people seem to be operating more on simple human instinct dealing with “unclean” things, or on some mangled version of biohazard containment, rather than any on sort of scientific information and confidence about what SARS-CoV-2 is capable of. And I realize that no one really knows yet, but ideally I’d like to find some sort of information that I can point people to, if they ask why I am or am not doing something in particular. So yes, is my home ineradicably coated with SARS-CoV-2 by now? Is it floating in the air and coating all surfaces? Why, exactly, do I wash my hands – does my skin shed SARS-CoV-2 like a herpesvirus, or is the worry that my hand might have touched a tissue that I coughed in, or something else? That sort of stuff. I don’t care about my own survival, but I’m willing to take reasonable precautions to protect other people. But I’ve already had my fill of ‘ah, unclean, burn the witch”, so I’m looking for something a bit more grounded in evidence.

        1. fallenscien

          The CDC’s and WHO’s guidelines are a decent baseline for what various people should be doing to protect themselves and others. It’s a good place to start for anyone who’s panicking, and it’s a good place to point if you want to justify any specific practices that are recommended there.

          Diving into the “why” of each recommendation is a separate, highly granular process. That’s how it works, right? Every question involves its own tiny universe of data.

          It’s hard to find a good synopsis that just has information on why we’re doing what we’re doing when every subquestion contains more-or-less infinite depths, our bibliography is the entire scientific corpus, and everything is constantly changing. The only good writeups I’ve seen are based around questions like “What are coronaviruses” not “What are all these recommendations based on.”

          Here are some core principles for your specific questions, though:

          * The point of most of these measures is to slow the spread of the virus throughout society. If we can lower the exponent on the exponential growth curve below 1, the pandemic fizzles out.

          * The real danger is infrastructural collapse if too many people get sick at the same time, since it’s a long-lasting illness that pretty frequently requires hospitalization, sometimes with a respirator, for weeks. Without this care, the fatality rate is significantly higher.

          * SARS-CoV-2 is a lipid-enveloped respiratory (and gastrointestinal) virus. It doesn’t become airborne on its own, but it can be carried on aerosols produced by coughing, sneezing, or (probably) breathing. Large aerosols tend to fall out of the air quickly, but fine aerosols can float for hours. Droplets tend to stick to what they land on, but can flake off or be transferred by touch later.

          * The virus is also shed in feces and possibly urine.

          * The virus can’t get through skin; it generally needs to get into your eyes, nose, or mouth to infect you. This can happen directly, from exposure to aerosolized virus, or indirectly, when people touch something that the virus is on, then touch their eyes, nose, or mouth.

          * The virus is resistant to drying out and can remain infective for hours or days on surfaces at room temperature, but is vulnerable to heat, soap, and many other common disinfectants.

          So to answer some of your specific questions based on these principles:

          * You wash your hands to avoid transferring virus. Virus can be transferred through a chain of touches, so it’s easiest to just interrupt that chain often.

          * The virus remains infective for days on surfaces at room temperature. So if you were recently shedding virus, or still are, then it’s all over your house. But it won’t be forever.

      4. Garrett

        To address the specific concern about the communal hose, could you bring your bike inside and wash it off in the shower/tub? It makes a bigger mess and is less convenient, but at least would likely be safer from the disease-spread point of view.

        1. keaswaran

          Or just wash your hands very thoroughly immediately before using the hose. As long as you don’t cough or sneeze or spit while washing the bike, there’s no reason to think your hands would shed any virus onto the hose.

    2. noyann

      physical distancing has interrupted my EMDR treatment

      Are you aware of self-EMDR?

      Should I try to get tested

      The current tests determine viral RNA. You are probably past the window where the virus will reliably be found. You’d have to get a test for antibodies, but these are not yet rolled out on a massive scale.

      How safe am I to go outside my apartment? etc.

      It all depends how sure it is that you did not have something other than Covid-19. Wait for a test (or at least expert’s opinion) before volunteering.

      1. Exetali Do

        Are you aware of self-EMDR?

        No, I was not aware… Those web sites look a bit cult-y, though. Can you vouch for them? (I’m a bit worried about the disclaimer “It will be noted that the authors do not advocate the use of EMDR or Self-EMDR with mental illness as defined in DSM5”.) Most of what I’ve seen indicates that EMDR should be done with a trained therapist, for anything non-trivial.

        You are probably past the window where the virus will reliably be found. You’d have to get a test for antibodies, but these are not yet rolled out on a massive scale.

        Thanks, that was exactly the sort of information I was looking for.

        It all depends how sure it is that you did not have something other than Covid-19.

        The shortness of breath was unlike anything I’ve experienced in my life. I was out of breath just getting up from my couch and going to the kitchen. (The rest of it was basically a medium-bad flu.) And I haven’t been especially careful, and I live in Seattle, and I used to take public transit all the time, until March 15th when Gov. Inslee started shutting things down.

        1. noyann

          self-EMDR? — Those web sites look a bit cult-y, though. Can you vouch for them?

          No. I only knew self EMDR (in various spellings) as a generic term for applying it to oneself.

          Most of what I’ve seen indicates that EMDR should be done with a trained therapist, for anything non-trivial.

          Agreed.
          I use it to quell raising anxiety, and also to deepen trance states for imagery work, self-hypnosis, working through material that is safe enough for me. In deep panic states self emdr had a tendency to get me stuck in a ‘trauma trance’, with only the horror and helplessness left but no ego structure / determination / will / agency to get out of it.
          You could ask your therapist if you two can develop a reliable way for your therapist to snap you out of such a trauma trance during a video session. E.g. have him/her keep some distance from the microphone and your volume turned up for normal loudness, and when a louder signal is needed, s/he moves close to the mic and speaks loud/yells/blows a whistle. Use trial passes without the traumatic material to test if it works.
          ETA: For the eye movement, sliding your focus along a horizontal line (edge of desk or a large monitor, window sill, corner between wall and ceiling) works well.

          …you did not have something other than Covid-19.

          The symptoms look like you had it, but there is a non-negligible chance that you did not. I guess nobody will take responsibility for you working for them (or helping out etc) if you can’t provide something written and certain, i.e., a test result, to cover their ass.

  29. LesHapablap

    Also, there are starting to be some econ papers trying to more rigorously analyze the pros and cons of lockdown. The Benefits and Costs of Flattening the Curve for COVID-19 says that “assuming that social distancing measures can substantially reduce contacts among individuals, we find net benefits of roughly $5 trillion in our benchmark scenario”.

    This is preposterous, and on reading the study it is clear why:

    . The value of statistical life (VSL) is taken to
    be $10 million, which is consistent with U.S. federal agency guidelines (9,10) and recent syntheses
    of the mortality risk valuation literature (11)

    They are using a value per life saved of $10MM, which has nothing to do with economic value at all. What do you think the economic value is of someone who is 70 years old, with diabetes, retired? Is it $10MM, which is likely greater than the sum of his salary for his entire working life? The answer is probably that your average unhealthy 75 year old is a big negative economic value, particularly in health care costs.

    That fact alone swings their numbers from +5T to -7T.

    In addition to their 10MM per victim, they also count the economic cost of the virus as a -2% GDP for 2020:

    In the uncontrolled scenario (without social distancing), we assume an immediate shock in
    GDP of -2.0%, due to the large number of excess deaths, loss of productivity due to sick days, and
    the inordinate strain on the health care system during the span of the outbreak.

    So they are double counting the economic cost of deaths, adding 10MM per person.

    In addition, their estimate of GDP with lockdowns comes from Goldman Sachs, who has since revised it. They use a ‘controlled GDP change’ of -3.8% for 2020. On March 31 Goldman Sachs revised their estimate to -6.1% GDP. link text link text

    So without tacking on the 10MM per victim, and using updated GDP estimates from Goldman Sachs, that gives us -16.5 trillion for lockdowns instead of +5 trillion. This is to save an estimated 1.2MM lives, for a cost greater than 10MM per life.

    On top of all that, their estimates for fatality rates are likely way too high: 1.5% for overwhelmed hospitals and .5% otherwise. We don’t have exact figures yet, but newer studies have found ranges of .1% to .26% (80000 hours. Germany just got preliminary results from their first wide population antibody testing and found an IFR of .37% in a very hard hit area (Reason. Which means the study’s estimates for lives saved by lockdowns is likely closer to 300k than 1.2MM. Which puts the cost per life saved as 40MM, and given the age and health distribution of victims, at least 4MM per QALY.

    1. Purplehermann

      Nice to see someone else looked at this. Would’ve just responded here if I’d seen it

    2. noyann

      What has been made public of the German study is heavily criticized for several methodological issues. Recommend waiting for at least the full manuscript.

    3. eric23

      Germany just got preliminary results from their first wide population antibody testing and found an IFR of .37% in a very hard hit area

      That area is the town of Gangelt, where infection spread during Carnival celebration in February. The celebrants in such a festival are overwhelmingly young, so the most one can say is that fatality rates *among young people* are about 0.37%. Among old people they are presumably much higher.

      Of course, your source is reason.com (which receives much of its funding from the oil industry, and thus has a strong incentive to dishonestly support any political party which denies climate change) so they wouldn’t mention such details…

      1. DavidFriedman

        I am having a hard time following your final point. Reason‘s source appears to be The Guardian. Do they deny climate change? Does Reason? Where is the connection between the fact that you disagree with Reason‘s political views and this particular story?

        1. eric23

          That is incorrect. The first link in the Reason article is to the Guardian. However, the Guardian only says that a study is being conducted, not what the results are. Reason relies on other links (in German) for the study’s results, and somewhat misrepresents what they say (the virologist in question suggested opening a few facilities like preschools and car dealerships, while maintaining social distancing otherwise, and suggest this only in the context of one particular town where immunity levels are already relatively high and the people’s hygiene measures are unusually disciplined, whereas Reason implies that the entire lockdown can be lifted everywhere).

      2. albatross11

        eric23:

        WTF? Is there some relevance to your comment about reason.com’s funding sources? What does their getting money from the oil industry (do they? I have no idea) have to do with reporting on a Germany study estimating the case fatality rate of the virus?

        I’m having a hard time interpreting your comment as anything other than a reach for some kind of reason to discard some unwanted claims of fact.

        1. eric23

          Reason is not simply reporting, it is omitting crucial context, and also somewhat misrepresenting what was actually reported in Germany. That the conclusions drawn from Reason’s bad reporting happen to match the political agenda of the Republican Party (prioritizing concern for the stock market over concern for lives) could be coincidence, but given the sources of Reason’s funding, seems questionable.

          1. DavidFriedman

            I don’t know how familiar you are with Reason, but their policy preferences don’t map very closely to those of the present Republican party. Consider issues such as trade or immigration or civil forfeiture.

    4. keaswaran

      “your average unhealthy 75 year old is a big negative economic value, particularly in health care costs.”

      I don’t think you understand what “economic value” is, if you think that it is possible for life to have a negative economic value without the person being actively suicidal.

      The economic cost to ending a non-suicidal life is bounded below by the present value of future potential earnings. Presumably the person has some positive enjoyment of life that isn’t monetized, and that positive enjoyment has economic value as well.

      It’s fair enough to say that $5-10 million are the statistical value of an average adult life, so that someone who is already quite a bit older has a lower statistical value of life. But once you start saying that a life could have close to *zero* or *negative* economic value, you’re just veering into silliness. (Again, if someone is having such an awful life that they are interested in suicide, then these values could be plausible. But I don’t think many deaths are like this. And of course, we have to consider not just the cost of all the deaths, but the cost of the suffering of “mild” cases – a friend of mine recently recovered and posted a picture her 6 year old had taken of her during the illness, after she had sat down on the kitchen floor from being too winded to stand up, after walking to the kitchen to get a cup of tea.)

      1. DavidFriedman

        But once you start saying that a life could have close to *zero* or *negative* economic value, you’re just veering into silliness.

        That would be correct if the life in question was not imposing costs on others. But imagine someone who is just a little happier than the suicide point, but who remains alive only because of large medical expenditures on him financed by the government.

        Alternatively, the same scenario with the expenditure coming out of his large savings — which, if he dies, will go to an heir who doesn’t much value the person’s life.

        At a slight tangent, I have long argued that, if one is going to make sense of utilitarianism, zero utility should be defined by the suicide point.

  30. eelcohoogendoorn

    Read that econ paper, and I am not impressed. There are not any detailed calculations to trace, but they try to state all their assumptions. They use $10M per life saved and 1.5% fatalities; with no mention of their assumption about what age brackets those deaths fall in. $10M seems generous when most health care systems are willing to spend well below 100k per QALY; but it is especially inappropriate for a virus the kills almost only people who are over 70.

    Also, I see no mention of how long exactly they expect these distancing measures to last. It seems implied they assume a recovery period will start soon. But what if after 6 months of isolation, we find ourselves essentially at square one; a quite likely scenario?

    I am betting that when the dust is settled, this will be known as the least cost effective medical intervention ever; and this paper does not convince me otherwise.

    1. keaswaran

      “$10M seems generous when most health care systems are willing to spend well below 100k per QALY”

      I’ve been seeing this sort of mismatch in several places recently. Most agencies seem to value deaths averted on the order of $5-10 million, while most entities that put values on QALYs or the like put them in the order of $10-100 thousand. The only way I can reconcile these numbers is if the “quality-adjustment” in QALYs is somehow overestimating the fraction of the value of life that is lost due to various qualitative changes.

      In any case, it would seem odd to value life itself (including recreation as well as work for pay) at less than the salary that a person could draw, as these QALY measurements seem to do.

  31. tallfoul

    @scott:

    The issue isn’t that none of the ventilators Musk supplied were the useful kind, the issue is that he effectively took credit in the media for supplying thousands of them, while actually only supplying a couple (and possibly only after he started to get negative publicity for the useless ones). My understanding is he pulled the same stunt when he took credit for supplying water filters to Flint, but which couldn’t filter lead, which was one of the main problems with the water.

    By the way you can be pretty sure that the hospital-thank-you-tweets and photos with Tesla branding on the ventilators (something no other donor has done as far as I know) are requested/demanded by Musk. It is the same PR behavior primarily focused on burnishing his image that was revealed in the deposition documents in the Unsworth trial. (Also note also that the hospital thanked him equally for the useless ventilators.)

    As for building ventilators, I wouldn’t hold my breath. At best he makes a couple of prototypes for the PR, maybe delivers one to a hospital for another photo-op and headline, never to be used.

    As even more evidence to be skeptical of what Musk says publicly and what he does for “benevolent” reasons, it came out today that he had complained to Stanford that they had potentially exposed his son to the Coronavirus — by inviting a Taiwanese student to a debate competition — a few weeks before he started publicly downplaying the severity of the disease, particularly among the young.

    1. HeelBearCub

      Do you have some link to indicate how many were actually delivered? I’ve seen reporting of hundreds in a particular hospital, and that these were converted to invasive ones. Where is your data from?

      1. tallfoul

        How many of what were actually delivered? Musk tweeted that he had 1200 “ventilators” to distribute and that he had delivered 40 to New York hospitals at one point. If a large number of those were nominally invasive ventilators he definitely would have made it known, particularly after having been criticized for supplying the useless kind.

        I haven’t heard of any of these ventilators being converted and I’m not sure any medical professional thinks it’s a good idea to do so (though I’m sure Musk would produce a photo-op with a converted ventilator if there was an article that pointed out that fact).

        The BiPAPs that *can* be converted (for example see here) are more complex hospital-grade devices that are nothing like the home version (and cost tens of thousands of dollars).

        It’s easy to see that the home version BiPAP devices are useless for treating coronavirus because they are still easy to obtain: you can go to Craiglist and buy the same model Elon donated used for ~$200, or buy one new from a retailer for $700. If they were actually useful hospitals and given the panic for ventilators at that point there would be a shortage and hospitals would be soliciting donations of ones people were using at home for sleep apnea.

        1. HeelBearCub

          Well, here is a Wired article that says that several hundred (still non-invasive, though) units were delivered to just one hospital, Mt. Sinai, and modified for use there. That’s quoting Mt. Sinai.

          I think that already debunks the “he only sent a couple”. This may be cynical PR stunt, Musk is certainly self-aggrandizing, but it doesn’t seem to be a complete fiction.

          I know I have seen other references to other conversions. Haven’t been able to dig them back up though.

          1. tallfoul

            Unless I missed it the “conversions” they describe in that article are not to convert to an invasive ventilator but to add a filter and O2 input.

            The point is that when there was an alarm sounded about a potential “ventilator shortage” they meant “invasive-ventilator”. As far as I know, no one was panicking about non-invasive ventilators. But Musk purposely conflated the two to falsely take credit for helping solve the problem that was making headlines.

          2. Radu Floricica

            @tallfoul

            All in all, there’s quite a lack of charity in this. He didn’t send any ventilators – ok he did but just a couple – no, there are hundreds but they’re the wrong kind – no, it’s the right kind but not the one that’s in shortage.

            At some point I just go “bleah” and have to assume he did a good thing, and the critics just have a bone to pick.

          3. tallfoul

            @radu

            Providing facts that refute counterarguments isn’t a lack of charity.

            And again, the issue is that Musk took credit for something he did not do. If he had initially said that he donated 2 invasive ventilators and 1118 for-home-use BiPAP machines that as he said later, might be used on less severe cases, (and that might be nice to have around in a World War Z better-than-nothing might-as-well-try-it if jerry-rigged scenario) then there would be no problem.

            Any reasonable person, not knowing anything else, would have concluded based on Musk’s statements that he made a much bigger contribution to solving the stated problem than he actually did. And it’s important that society be able to distinguish the actual (and not claimed) magnitude of societal contributions, not only to make sure that problems actually get solved but also to grant the appropriate status and goodwill to the person doing the contributions.

          4. Loriot

            All in all, there’s quite a lack of charity in this. He didn’t send any ventilators – ok he did but just a couple – no, there are hundreds but they’re the wrong kind – no, it’s the right kind but not the one that’s in shortage.

            I’m not tallfoul, but Musk lost all goodwill I had years ago due to his previous stunts. Remember him promising a fanciful submarine to rescue people trapped in a cave in Thailand and then publicly insulting the diver who actually rescued them? So my prior now is that anything he does is a meaningless PR stunt until proven otherwise.

          5. albatross11

            Loriot:

            Okay, but that just tells me your priors, not whether he also did some dumbass publicity stunt this time or somehow actually helped out.

    1. HeelBearCub

      I believe it’s already been linked that the ventilators Musk delivered had been converted to invasive ones.

  32. Cheese

    “UK clinical guideline body NICE now officially recommends against using NSAIDs for coronavirus.”

    Hi Scott. I’m not sure that’s the best way to put it, nor is it a paritcularly strong piece of evidence for anything in a debate about NSAIDs.

    They say to preference Paracetamol (which is basically what everyone everywhere does anyway in basically all situations unless there’s a specific NSAID indication – it’s a safer, more effective painkiller and antipyrexial in all but those specific situations). This is not the same as “officially reccommending against” NSAIDs. There is also no additional data referenced beyond the previously discussed French preference.

    While I am generally not a fan of media coverage of treatment related issues, there is no additional data that has changed since the back and forth that occurred a few weeks ago. There is a big reference circle of press-releases that end up all in exactly the same place.

    Re: Viral load. I quote from the article published April 1: “The importance of viral dose is being overlooked in discussions of the coronavirus”

    No. It’s been mainstream in Resp/ICU/ID circles specifically with reference to COVID for about 2 months as a theory to explain the outsized numbers and severity of healthcare worker infections in China. To be frank, it’s not something i’ve followed. My understanding is that the literature as a whole is suggestive that innoculum size probably matters (reliable mouse data AFAIK) quite a bit but that human data is (as usual) full of weird contradictory caveats. I can’t really see it being useful to the public health discussion at this stage. Minimising exposure in society naturally reduces the chances for high-dose innoculation as a natural consequnce. Variolation is a bit of a separate discussion that probably needs more real-world data because it is the kind of thing that could go very wrong very quickly.

  33. 6jfvkd8lu7cc

    Re: viral load discussion in mainstream — is there something true that can be said that would make more people wear masks out of the hope (even though there is no data to know more or less anything about masks) of downgrading the infection severity?

  34. Maxander

    The prospect of remote voting shenanigans in November makes me think of the old “obviously-idiotic Trump vs secretly-11-dimensional-chess-playing Trump” debate; 11D-Chess Trump would definitely right now be angling towards making sure that COVID19 was still a problem in November, ensuring that whatever happened in terms of actual votes the electoral machinery would be such a mess that victory could be claimed, in some form, with the low degree of plausibility he tends to require to justify his actions. Letting up on social distancing policies in April certainly would go a long way towards this condition.

    I am aware that that old debate was basically resolved in favor of Obvious-Idiot Trump, who would also be in favor of back-to-normal policies in April for his own reasons. But the central paradox of that whole question was the unnervingly consistent rule that both possible Trumps, despite their fundamental differences, act indistinguishably.

    1. mtl1882

      I really think Trump is mostly focused on just trying to get the country stable again at the earliest possible time, both because almost everyone wants that, even if they disagree on how to go about it, and because his election prospects depend on the country not being a total disaster. No need to get much fancier than that, even if he is a 4D chess player. When it comes to reopening, avoiding economic collapse is a much more likely motivation than timing the second wave for November. But the paradox can be quite amusing, I agree.

      I mean, this election is just not good in a lot of ways, even if Trump doesn’t do a thing. Everyone is going to be able to claim the results were unfair–the situation was enormously bad luck for leadership in both parties and has greatly interfered with campaigning, crashed the economy, distracted voters, etc. Almost certainly enough will be afraid to vote in person that if we don’t vote online, people can claim that disadvantaged their side. If we do vote online, it is quite easy to come up with allegations of fraud, and I believe democrats tend to vote more online (which isn’t wrong, but will naturally lead to complaints by republicans that a freak event screwed things up for them).

      And I imagine that there’s a good chance that the vote will be quite close, making all these complaints seem more important. Then you have all the crazy claims that Trump is going to refuse to leave office if he loses, and that he’s already become an authoritarian leader. It certainly isn’t an election where we could postpone things or accept a very botched process—people really care, and we can’t risk it looking like there was an actual authoritarian takeover. There’s no way to make this go well, and everyone is going to howl. It’s not good.

      1. HeelBearCub

        Please, for the love of God, no online voting, especially not put together over the course of a few months.

        I hope you just meant “by mail”.

    2. anonymousskimmer

      Trump insulted McCain, and thus lost an election promise (that other Republicans had to bend over backward to try to make happen as best they could).

      That is not indistinguishable acting. What’s indistinguishable is that Trump claims credit regardless of who did the heavy lifting, or how much of his promise came to fruition – i.e. his sales pitches are indistinguishable, not his actions.

  35. Douglas Knight

    The two different interpretations of “flatten the curve”. I think this explains why so much of the discussion around this phrase has been confusing.

    Your link uses the word “mean,” not “interpret.”
    Why do you think that the phrase means anything? Do you think “Masks don’t work” means something?

    Again,

    Hypothesis: “Flatten the curve” took off because it allows people to participate without 1. signaling they care what happens to them. 2. think things will get bad or 3. think bad things are preventable. — Elizabeth

  36. Brett

    Anyone else baking bread? The sourdough stuff seems to get all the attention, but I managed to get some instant yeast and the rest of the cooking ingredients (including a huge Costco bag of bread flour), and I’ve been mostly cooking fresh french bread (I’ve got a bread machine which I mostly use for making dough I then cook in my oven). I found a pretty good recipe online and printed it off, with some modifications.

    I’m thinking about trying soda crackers next. You can also make a pretty decent cake if you’ve got an instant cake mix plus a can of soda – I made it for the Super Bowl this year. I might make one for Easter, since it’s riskier to go buy chocolate.

    1. DavidFriedman

      We generally get our flour in 25 lb bags from Costco — my XMas present to my daughter a year or two back was a flour container big enough to hold that much. So far we are spending down the loaves in the freezer, but once that runs out either my wife or I will start baking.

    2. Lambert

      Well it’s Holy Saturday so I’m just proving some hot cross buns.

      Luckily I’ve a bunch of saffron and orange blossom oil left over from making a pannettone so I can make them appropriately decadent, even though eggs and butter are hard to come by.

    3. DavidFriedman

      And my wife is now also making hot cross buns.

      My next baking project will be to try to make hamburger buns (to be eaten with the BBQ pork sous vide I made a few week ago) for my son, since he has just about run out of the commercial ones we had. The question is whether I can produce something enough like his usual so he will like it. The usual is all whole wheat, no white flour, which is a bit of a challenge.

      1. Lambert

        How’s commercial bread in the USA made?

        I’d always assumed it was some variation on the Chorleywood process (CBP).
        But Chorleywood itself seems to be mostly associated with the UK (where it’s used to make 80% of loaves). A lot of CBP seems to be about developing the gluten as fast as possible using high-speed temperature controlled mixers and the addition of ascorbic acid. Since american flour tends to be harder than british, this might not be necessary.

        The common thing going on seems to be trying to make the bread as fast as possible, so you can get the same throughput out of a smaller factory. Techniques like aeration (using pressurised CO2), proving/baking above/below ambient pressure and adding enzymes seem to be the way in which this is done. IMO, this creates a very flavourless bread, compared to traditional techniques.

        I’m not sure exactly where this comment is going but my advice would be to break into a well-stocked food science lab and see how fast you can make some baps/buns/semmeln/rolls/teacakes/brötchen.
        The anglophone world deserves better bread.

        1. DavidFriedman

          My own standard is a sourdough raisin bread and very tasty, so I don’t need to break into any labs. My son has no objection to either my bread or any of my wife’s (yeast rather than sourdough) breads for other purposes, but has decided that a particular variety of a particular brand of commercial hot dog/hamburger bun (they make both shapes) is the perfect thing for eating BBQ on, despite the fact that it does not taste nearly as good as the home made alternatives.

          Which produces an interesting challenge for me.

    4. Controls Freak

      I generally buy a pretty sizable container of yeast each year, use a lot of it through the year, and then toss it before passover. Very unfortunately, passover is happening right at the same time that we’re seeing yeast shortages across the country. I have friends from multiple parts of the country who have reported that yeast is nowhere to be found in their stores, and the last time I went there wasn’t any here either.

      Can anyone provide some inside baseball on this? I’ve seen articles discussing how market dynamics are working for a variety of other products, including that flour production isn’t an issue (there was still plenty of flour at the store here) and how the different demand between restaurants/homes has driven issues in the dairy market… but what’s going on with yeast? Can I expect to see some again soon?

      1. Edward Scizorhands

        In lockdown, everyone wants to bake their own bread, so a bunch of new players are buying up the yeast.

        1. Controls Freak

          Sure, but like I said, that would impact flour, too. Yet, supplies there are fine. I didn’t outright say the details, but I’m contrasting this to some articles I’ve read about the inside baseball on the dairy industry. Apparently, they have significant packaging differences for restaurants than for homes, and folks are literally throwing out milk because they don’t have the capacity to package products in the form usually consumed by households.

          I’m guessing that flour doesn’t have this type of packaging capacity issue? Is there a similar issue for yeast? Is there something else going on? Surely, we’re not baking super significantly more bread at home than we were consuming overall before. Where is the backlog, and is it likely to be resolved anytime soon?

          1. Garrett

            An alternative hypothesis is that bread consumption overall is remaining stable, thus flour consumption is remaining stable. Distribution is probably changing from bakers to home consumers which matters less if packaging capacity is still there. But you can imagine that large-scale commercial bakeries either maintain their own yeast cultures or use non-yeast production methods. With a large increase in home baking you might get a shift in flour packaging for sale but an absolute increase in the demand for yeast in the market.

          2. keaswaran

            For most of March I saw shortages of flour in the grocery store. It’s only when we went shopping at 9 am on a Monday, and were able to find toilet paper, that we also found flour. Perhaps flour has rebounded where you are, and yeast is just taking a few weeks longer?

        1. Controls Freak

          I’m only what I call “Jew-ish”; I don’t know what the Halacha says. It’s always been my custom to actually get rid of it, and I’m not really the type that goes looking for technicalities (especially when they feel sneaky). If it results in me going without for a bit afterward, so be it. I’ll survive.

          (I’ve already gotten rid of it all. The question is more about, “When I swing by the store sometime next week, will there be any chance, or should I just plan to figure out the whole sourdough thing?” A side of, “I’m hoping to get an interesting market story.”)

          1. DavidFriedman

            and I’m not really the type that goes looking for technicalities (especially when they feel sneaky)

            In the words of a commenter on my blog, reacting to my criticism of Rabbinic law:

            The Most Perfect One who made the law also made the loopholes.

  37. Logan

    I’m a professional mathematician, not an epidemiologist. I want to talk about what “flattening the curve” means, re: the 538 link. There are many distinctions that “flattening the curve” has become shorthand for, more than just two.

    First of all, imagine a homogeneous population (meaning given any two people, the chance of them infecting one another is a single constant number). The relevant numbers are R_0 (the *basic* reproduction number, the average number of people a random patient will infect over the course of their disease *if everyone were susceptible*) and R (the reproduction number, the number of people you infect in practice). Obviously, R is just R_0 times the percent of the population that is susceptible. If half of the population is immune, then you will only infect half as many people (because half your sneezes land on immune people).

    The following are all equivalent: (1) the peak is over, (2) the number of infected people decreases each day, (3) R is less than 1, (4) The percent of people susceptible is less than 1 / R_0, (5) we have achieved herd immunity.

    That’s all assuming a homogeneous population with a constant R_0. I think when people talk about herd immunity, they in practice mean we’d have no outbreaks even if we lifted the social distancing. This is kind of nonsense though, at least theoretically, because the herd-immunity number depends on R_0. The R_0 for Covid-19, without any social distancing, has been estimated to be 3 (huge error bars, obviously). That means you need at most 1/3 of the population to be susceptible (or at least 2/3 to be infected) in order to prevent outbreaks *without social distancing*. But currently, with social distancing, the R_0 is like 1.1 so we’ll hit the peak when about 10% of the population has gotten sick and (hypothetically) burn out the virus long before we reach herd immunity. In practice there will be enough noise that we would continue to get some low level of infection forever, then when R_0 goes back up to 3 we’d be in the exponential regime again.

    So that covers the ambiguity due to R_0 which changes over time. What about ambiguity due to R_0 that changes in space (i.e. different people have different infectivity). That’s what is accomplished by quarantine, including contact-tracing. I think when flatten-the-curve first entered the vernacular, it was in contrast to containment, which essentially means divide the population into multiple groups (infected and vulnerable, either at the individual level or the household level or the city level etc) and drastically reduce the interaction between those groups. But in practice that containment won’t be perfect, so really you’re just trying to reduce the effective R_0 between groups to be low enough that the number of infections decreases over time.

    Literally every pandemic counter-measure results in the curve being flattened, by definition of counter-measure. Containment and social-distancing and intermittent social-distancing all, literally, cause the curve to become flatter. The virus gets better if (the R_0 in some specific circumstance) x (the percent of people you interact with who aren’t immune) is less than 1, which will happen immediately if R_0 less than 1, and eventually if R_0 greater than 1. But the virus will always get worse when R_0 increases (i.e. when we lift whatever measures we are taking), unless the virus has been eradicated (which is not likely possible at this point). Herd immunity can only ever happen if we either 1) let at least ~2/3 of the population get sick, meaning .6% of the population dies, or 2) only maintain that herd immunity so long as some kind of R_0 reduction is in place.

    In conclusion, “flatten the curve” is an excellent way to understand how countermeasures interact with hospital resources, and a terrible way to differentiate between different countermeasures.

    1. The Nybbler

      (4) The percent of people infected is less than 1 / R_0

      Susceptible, not infected.

      There’s also a distinction between the herd immunity threshold and total number of people infected (epidemic final size); unlike the herd immunity threshold, epidemic final size is path dependent so temporary measures can reduce total number of people infected.

      The problem with all this is that the models don’t correspond to reality. Their inputs aren’t great either. We’ve seen epidemics (including 2009 H1N1) which burn out before reaching herd immunity (let alone theoretical final size). SARS simply disappeared, which epidemiologists cannot really explain. This virus is already strange; what can explain the difference between Wuhan, New York, and Tokyo?

      1. Logan

        The SARS burnout has been explain by epidemiologists (in the couple of times I’ve heard it talked about) by the ability to rapidly contain infections.

        If someone is sick for 2 weeks, and only symptomatic in the second week, then isolating anyone who becomes symptomatic reduces R_0 by half. For comparison, the first SARS (I say first because, apparently, they’re the same species of virus, which is a fun fact) you couldn’t spread the disease until after you were symptomatic, so just by isolating symptomatic people they could reduce R_0 to close to 0.

        Remember that reducing R_0 dramatically is relatively easy for viruses that don’t have a prolonged period of asymptomatic spread.

        1. The Nybbler

          I consider that explanation insufficient. SARS made it around the world, and then the public health authorities in every affected country managed to find and isolate every case? That presumes a level of ultracompetence that is clearly contradicted by the evidence.

          1. eric23

            “Around the world” doesn’t mean much when there are only 8000 cases in the entire world. It doesn’t take that many staff to find all 8000 cases and their contacts. There are many millions of doctors in the world.

  38. Erusian

    I’m surprised by this, because I would have expected mail voting, as opposed to booth voting, benefits people with good executive function who are familiar with doing things by mail – ie older, richer people, ie Republicans. It would appear that I am wrong.

    There’s good studies on this. Mail voting ends up benefiting Democrats over Republicans about two to one. This is because it primarily enables voting among lower class urban voters (and, according to some Republican analyses, some degree of voter fraud.) It doesn’t enable rural or suburban voters nearly as much because it correlates pretty well to post office density.

    An alternate proposal that would be less partisan beneficial for the Democrats would be the Indian model. Indian elections are designed to decrease travel and wait times as well as to accomodate a wide range of time preferences but still require actually showing up to the polls. Generally they have a poll about every two miles. This means they set up polling stations in tiny rural hamlets with five people. This improves turnout among a variety of groups, some of which are associated with Republicans and some of which are associated with Democrats.

    As it is, both sides favor systems that encourage their blocks to turn out.

  39. tvt35cwm

    The Medium piece on “the mystery of Japan” seems to imply that Japan will soon see a tsunami of cases — the relative absence of cases was simply the suck-back before the sea comes surging in.

    On the positive side, it provides a highly plausable narrative for the value of wearing masks.

    But especially, for not talking. Shoot all the extroverts! *

    *Texans and similar: this is not an instruction or advice. It is humor.

    1. eric23

      The Medium piece on “the mystery of Japan” seems to imply that Japan will soon see a tsunami of cases — the relative absence of cases was simply the suck-back before the sea comes surging in.

      Not really. It says that Japan’s measures worked somewhat well but not well enough. In numerical terms: Japan’s measures led to a ~8% daily increase in cases, rather than ~33% like in all Western countries. But now, that ~8% increase has finally lead to an absolute number of cases where further ~8% increases can no longer be tolerated, so lockdowns are now needed despite the economic cost.

  40. Pandemic Shmandemic

    How do we feel epistemically about the pieces* suggesting that the Wuhan wet market was framed and the epidemic originated in a BSL-2 facility of the Chinese-equivalent-of-the-CDC lab that was studying bats ever since the first SARS epidemic and happened to be located a mere 300 meters away from the said wet market ?

    * https://www.dailymail.co.uk/news/article-8009669/Did-coronavirus-originate-Chinese-government-laboratory.html
    * https://www.nationalreview.com/2020/04/coronavirus-china-trail-leading-back-to-wuhan-labs/

    1. Edward Scizorhands

      Low probability. If the Chinese really accidentally loosed a bioweapon, they would have put the pieces together very quickly and brought out all the tools of an authoritarian regime to suppress it while it was still easy to suppress.

      1. Pandemic Shmandemic

        They do not suggest it was a bioweapon or an engineered virus, just that the infections began with researchers in the facility from bats kept there for research and not from bats sold on the market for food.

      1. Doctor Mist

        Hmm. It may well tell us nothing useful about how to deal with the disease, but it might tell us very useful things about how to deal with China going forward.

        A murder trial does not bring the victim back to life, but it is worthwhile nonetheless.

        1. truckdriver20

          There’s nothing about studying this type of virus that would indicate bad intent, it completely falls under the umbrella of legitimate scientific research. Only thing you could fault them for is poor safety practices. Honestly I think the official theory makes the Chinese look even worse.

          1. Doctor Mist

            Perhaps. I didn’t say what it might teach is, only that it might teach us different things. But I sort of think the official theory indicts Chinese culture while the lab accident indicts the Chinese government — which might explain why the Chinese government has been so obstructionist.

            Mind you, I have no real opinion about the odds. I read somewhere that the alleged lab is actually much farther away than that from the alleged wet market, and so could not have really been the source. But since I have no memory of where I read that, I must remain agnostic.

          2. Douglas Knight

            As your NR link says, there are two labs. But then it goes on to mix them up. The one 300m from the market is BSL-2. The Wuhan Institute of Virology, 10km from the market, is BSL-4, the first in China (2015). Union Hospital is 300m from the market. I have not been able to confirm that there really is a WHCDC lab in or next to Union Hospital. There is another WHCDC location 3km away.

          3. anonymousskimmer

            I can’t remember the specifics, but I’ve heard that the director of the Wuhan Virology Institute is basically a nepotistic appointment.

            I have no idea how, or if, this reflects on the rest of the Institute.

          4. Douglas Knight

            Update: I have confirmed BX’s claim. 武汉市疾病预防控制中心 means Wuhan CDC. It is listed in the baidu map in several locations, one of which (#1 for me, near the green subway line) is just north of the Union Hospital and 300m from the Market. I don’t know if it has a lab there, but putting labs next to hospitals makes sense and BSL-2 is a pretty low level.

      2. Pandemic Shmandemic

        It kinda does, if the facility indeed was studying bats for their viruses we can assume the bats kept there carried more viral load than the average bat sold on the market for food, also they mention incidents of specific researchers being exposed and a paper linking the disease to the facility that has since then been taken down.

        1. DaveK

          I don’t buy the released bat theory, but in a bioweapons lab, you study many viruses that aren’t actual bioweapons. They may be bioweapon candidates, or can teach you things about what may or may not work in regards to bioweapons, generalized research.

          I understand China is actually more corrupt then the picture the CCP presents, but I would be a bit surprised by a level of incompetence that allows people who work at bioweapons labs to resell bats killed in research at wetmarkets, even if it was a case of corrupt low level people as opposed to official policy.

          1. Pandemic Shmandemic

            They do not suggest the facility was in any way bioweapon related, or even that a bat was released – they say the facility housed and studied bats for their viruses since they were implicated in the original SARS outbreak (SARS coronavirus 1), took poor precautions and had several incidents with researchers getting exposed the last one triggering the COVID19 outbreak.

      3. Etoile

        If true, I think it does in that it would remind us that China is probably fiddling around with biotechnology and genetic engineering in a potentially problematic way — particularly if you find evidence (if you can even find such evidence) that the virus was somehow augmented or engineered.

        1. DaveK

          I think that is even more of a concern for less organized states as such technology becomes more widely available.

    2. John Schilling

      Plausible but unlikely, difficult to prove or falsify without the cooperation of the Chinese government, and largely irrelevant going forward. If we could say with any confidence that it was an actual Chinese bioweapon, that would be relevant but is even less likely.

    3. Simultan

      From The proximal origin of SARS-CoV-2 (March 17th):

      The genomic features described here may explain in part the infectiousness and transmissibility of SARS-CoV-2 in humans. Although the evidence shows that SARS-CoV-2 is not a purposefully manipulated virus, it is currently impossible to prove or disprove the other theories of its origin described here. However, since we observed all notable SARS-CoV-2 features, including the optimized RBD and polybasic cleavage site, in related coronaviruses in nature, we do not believe that any type of laboratory-based scenario is plausible.

      So it seems very unlikely.

      1. Pandemic Shmandemic

        Gaah, NOT. A. BIOWEPAON. CONSPIRACY. THEORY.

        The virus is assumed to be entirely natural just said to have leaped to humans in lab that was studying bats, not the wet market.

        1. thehousecarpenter

          The paper is talking about “any kind of laboratory-based scenario”, explicitly including the possibility of an accidental escape. Look at the section entitled “Selection during passage”. I’m not a virologist, and this is a Nature paper and hence frustratingly concise, so I’m not sure I understand what they’re saying very well. I think they might be saying that this virus exhibits prominent features that make it more capable of infecting humans, that one would expect to have been noted in the literature if the virus was studied in the lab, but no record of such findings was ever made in the literature.

          I imagine it’s a lot more difficult to find evidence against the possibility of accidental release compared to evidence against deliberate engineering, since deliberate engineering is likely to produce unnatural-looking artifacts, but accidental release can easily happen without that happening. So I think a major factor on people’s opinions about this will be their priors about how relatively plausible these different scenarios are. To me, it does seem a lot more plausible that it would happen via marketplaces engaged in a dodgy wildlife trade than a high-security virology laboratory staffed by people who understand these risks well. Especially since SARS is supposed to have emerged via the former as well (although I haven’t looked at how strong the evidence is for that). Of course this is only based on a superficial knowledge of those two environments. But the statements of virologists in the papers I’ve read suggest they have similar priors.

    4. Radu Floricica

      Were they making viruses? AFAIK this was already debunked – not sure how obvious it would be a virus was engineered, but we don’t have any indication that it was. I have no opinion on that front due to insuffcient knowledge

      If it wasn’t, it’s just Occam: you have a few dozen (hundreds if you want) bats in a secure facility, vs many many bats over many years in wet markets all over China. Many many bats.

      So the chances are, I guess, proportional – so small.

      1. Pandemic Shmandemic

        There’s no suggestion that they were “making” or engineering viruses, but they are said to have been studying corona viruses in bats so it makes sense that the bats there would be more heavily infected that an average bat in nature.

        Re. “many many bats over many years in wet markets all over China” – do we know this is in fact the case ? My understanding is that while bats are sometimes consumed as traditional remedy they are hardly a staple food in China

        From wikipedia

        East Asia, specifically southern China, bats are sometimes eaten and can be found in some markets.[4] Specific bat species eaten in China include the cave nectar bat, Pomona roundleaf bat, Indian flying fox, and Leschenault’s rousette.[14] Additionally, the greater short-nosed fruit bat is hunted for medicine, but not food.[14] Bat meat is not especially popular in China.[17][18][19] It has been contested whether or not the Huanan Seafood Wholesale Market, suspected as having ties with the COVID-19 outbreak, sold bat meat.[20][21] According to some sources bat meat was never sold in the market

      2. Robert L

        It isn’t “just Occam;” the principle does not say that the apparently easier explanation of something is necessarily the correct one. The one you reject does not posit additional entities to explain anything, so Occam is irrelevant.

        Your argument fails for other reasons. The security of the facility is rather counterbalanced by the fact that there are good and relevant reasons for making it secure, for instance.

  41. Paul Torek

    BiPAP may be an equally effective and less invasive treatment for Covid-19. One small bit of the picture:

    Researchers and clinicians on the front lines are trying. In a small study last week in Annals of Intensive Care, physicians who treated Covid-19 patients at two hospitals in China found that the majority of patients needed no more than a nasal cannula. Among the 41% who needed more intense breathing support, none was put on a ventilator right away. Instead, they were given noninvasive devices such as BiPAP; their blood oxygen levels “significantly improved” after an hour or two. (Eventually two of seven needed to be intubated.)

    Hat tip: Brian Leiter

    1. albatross11

      Downside: BiPAP and CPAP are believed to facilitate airborne spread of the virus by creating an aerosol. Even high-pressure oxygen in a nasal canula probably does some of that.

  42. SolipsisticUtilitarian

    The article on Japan’s new rise in confirmed cases does not mention the explanation that is the most obvious to me: Japan tried to suppress confirmed numbers to not endanger the Olympics. But when that failed, Japan basically said: “No point in keeping up the facade now”, and started to report more accurate numbers.

    1. eric23

      The case growth rate in Japan hasn’t significantly changed in period before and after the Olympic announcement. So your theory seems pretty unlikely (even if for some reason one had no prior against conspiracy theories)

      1. Loriot

        Also, there’s a limit to how much you can cover up an exponential outbreak. I doubt Japan wanted to cover up things any more badly than say, Iran.

  43. Rana Dexsin

    I’m surprised by this, because I would have expected mail voting, as opposed to booth voting, benefits people with good executive function who are familiar with doing things by mail – ie older, richer people, ie Republicans. It would appear that I am wrong.

    (1) I have mainly biased experience here, nothing well-analyzed or calibrated, but that’s the opposite of my intuitive priors. I would have expected more social-order-oriented people (like Republicans) to prefer things like “getting there on time” and “showing your face” (and “showing your ID”…), whereas leftists (often Democrats) who have or want to support people who have the aforementioned poor executive function, or possibly financial tenuousness, etc. would want people to be able to dither about with the mail-in ballot at home, have the opportunity to see it lying there on their desk for several days in a row as a reminder, and not have to figure out: where the polling location is; how to get there; possibly how to pay for getting there; how to not have the entire time it’s open blanketed by work shifts at the service job someone can’t afford to lose; and so on.

    (2) Alternatively: rich people with good executive function who care about voting will manage to do it regardless of the hoops they have to jump through. Poor people with bad executive function who don’t have much energy to care about voting might only manage it if the vote comes to them rather than the other way around, so if the latter group is more often Democrats than the former, then I would expect representation of Democrats to increase when voting by mail is available.

    (3) Alternatively: is your expectation partly based on the idea that it takes more executive function to handle voting by mail than voting in person? Because I’ve usually had a pretty poor executive function myself, and that difference runs the other way around for similar activities for me. If I had to go somewhere in person to pay my electric bill every time, I’d wind up with a lot more late fees.

  44. fion

    Wait, you don’t have postal voting in the US? In the UK anybody who wants can sign up for a postal vote as long as they register for it far enough in advance.

    1. hnau

      Voting in the US is managed by the individual states. Some states have postal voting as you describe but I’m not sure how widespread it is.

    2. Corey

      Everyplace in the US has a procedure for “absentee” ballots, so people can vote if out of the area on election day, or homebound etc. (Houston has a procedure involving proxies but not the mail, for ISS astronauts to use).
      Time was, in most places, you had to have a reason (affirm you would be out of town, etc.) to request one.
      Nowadays, many places have “no-excuse” absentee voting, so anyone can request a mail-in ballot.
      No-excuse absentee voting is what enables early voting – at least in NC early voting is legally an absentee ballot that you happened to get, fill out and drop off in person at an early-voting site. (They’re also labeled with an ID that tracks back to the voter, unlike Election Day ballots. This enables same-day registration and voting for early voting here; if the registration doesn’t go through, the ballot can be un-counted).
      Oregon (and possibly other places) have went entirely vote-by-mail.

  45. hnau

    Warning- possibly uninformed and unhelpful take:

    In the last few weeks the media, internet, public and elite opinion, etc. have crossed over from “insufficient attention to coronavirus” to “excessive attention to coronavirus”, due to hype and herd mentality effects. At the margin, spare attention / time / money would be better devoted to other causes.

    Anyone care to change my mind on this?

    1. Edward Scizorhands

      Like watching the plane crash into the WTC over and over again, we keep watching the news long past the point where it’s healthy for us.

      A prepper blog shared here emphasized that tuning out of the news was going to be very important to one’s mental health. They said that a few months ago, before everything became all-corona-all-the-time.

      1. Corey

        On one hand, reading Twitter daily and threads like this helped me get my panic-buying in before the rush, and masks made before it was cool.
        On the other hand, like with politics, the day-to-day minutia is of no consequence whatsoever, and will just crank up anxiety.

    2. eric23

      I think the amount of media attention is in proportion to the effects on people’s lives (no leaving the house except for a few specified purposes!)

  46. glorkvorn

    Here’s my guess for what happens next:

    Rest of April: infection/death rates decline almost everywhere. Everyone begins patting themselves on the back.
    May: Gradual end to social distancing and shut downs. It varies by city, and by individual. Some people try to warn that the virus is still there and it will come back, but there’s no way to enforce it on an entire country when people aren’t scared anymore.
    June-July: Most places open and back to business as usual, infection/death rates still low. Everyone forgets this thing ever happened.
    August-September: It grows exponentially again, and we’re right back to where we are now. Thousands of deaths per day, not nearly enough testing or ICU beds, no vaccine in sight.

    So what happens then? Do we do another 2-3 month shutdown? Do we try and shut down for a year or more, until a vaccine is developed? Do we just accept the mass deaths of a “herd immunity” strategy? Or what? I want to be optimistic because so far it has grown much less than the initial warnings, but I’m worried that we’re just delaying the inevitable. Social distancing has worked better than expected, but how long can we really keep it up?

    1. truckdriver20

      We’ll need to slowly open up to a state of “mostly-normal” until we get the vaccine. This could look like: masks, bans on large gatherings, voluntary social distancing urged, crowd control, mass testing and tracing concentrated in high-density areas, white collar workers continuing to work from home, bars and restaurants opening up at half capacity…. schools could even remain closed for another year if necessary and it wouldn’t blow up society, the kids would love it. Is there a reason to think these mitigation tactics won’t work or won’t be applied? Right now I think cautious optimism is very much warranted.

      1. glorkvorn

        I feel like if we don’t enforce those measures, not enough people will actually follow them. Everybody will want to go to church, have a wedding, have a party, etc all at once. Maybe 50% of people will still avoid big gatherings, but the other 50% will still spread it.

        1. truckdriver20

          Yeah I think bans on gatherings of over x people should probably be enforced

          The churches kind of worry me, these were the sites of the main contagion events in Korea. I think large centralized religious organizations eg the Catholic church will be socially responsible and have people space themselves out on the pews, drink communion wine out of disposable cups, etc. but at least a few of these independent Baptist churches and megachurches and whatnot are probably going to act like retards and it will be politically unpalatable to enforce actions against them. Don’t think this is insurmountable but idk how I would deal with this if I was a public health authority, it’s tricky.

          1. albatross11

            I think the choir practice case demonstrates that we need to keep churches, concerts, and sporting events shut down for awhile longer–singing, shouting, yelling, cheering, etc., probably launches tiny virus-laden droplets a great distance, where they happily float around until some previously-uninfected person inhales them.

          2. truckdriver20

            Idk if I’m entirely convinced that the choir practice story is true but yeah if it is then it becomes an even bigger issue. Good luck getting hardcore religious people to see the logic though

          3. DaveK

            While you hear about a lot of individual pastors and churches wanting to defy orders, those people are getting a disproporionate amount od media attention. The vast majority of churches and religious leaders support social distancing and are not holding in person services.

          4. keaswaran

            I live in a suburban town in Texas, and the four churches within two blocks of my house have all been shut down since mid-March, with no signs of any protest. One of them is still doing their Thursday food kitchen for the homeless, but with lots of people enforcing some sort of social distancing (I’m not entirely sure how effective their methods are, but they really at least seem to be earnest and partially effective, and it suggests that they aren’t champing at the bit to get the congregation back in).

        2. Edward Scizorhands

          There’s likely a bell curve, where 10% of people are going to do extreme social distancing even if not ordered; 10% are going to be dangerous despite orders; then a spread in-between.

          So maybe that dumbest 10% is getting infected now, despite our best efforts. (Note: being infected now doesn’t mean you are in that 10%, just that you are their victim.) So if we start relaxing rules, they would be the first to crowd the bars and beaches, but they already have gotten some herd immunity to slow the spread.

          That’s a long string of “likely”s and “maybe”s, though.

          1. albatross11

            This graph shows a massive fall-off in demand for tables at restaurants–note that this includes places that didn’t have lockdown orders. People everywhere suddenly thought “Geez, I don’t want to catch the plague just to go on a date with my wife tonight–guess I’ll order out or stay home instead!”

            There were surely people on the right tail of the “go do stuff” distribution who still wanted to sit in a crowded bar or restaurant, or go hang out on a crowded beach, or whatever. But not all that many.

          2. Clutzy

            Yeah, we went to dinner the Friday before my birthday and it was dead. Probably a top 3 restaurant experience I’ve had.

          3. albatross11

            The last time my wife and I went out to dinner, just before the real panic started, the restaurant was separating tables by more than 6 feet and there were very few customers. It was already starting then. Most people don’t want to catch something that’s like a really bad case of the flu but then it sometimes goes into pneumonia and kills you.

    2. Le Maistre Chat

      We’re going to get into a very bad situation in the lead-up to Christmas. Elected leaders ordering their people not to go to church and avoid all large gatherings for Christmas? That’s asking for open rebellion.
      I know the Catholic Church and a lot of others have chosen to shut to the public past Easter, but the medical experts were advising that like only one month before Easter. Christmas more than 9 months into the lockdown and a much bigger deal to everyone but the devout core.

      1. HeelBearCub

        If we make it to Christmas still under lockdown, I think it will (almost but not quite certainly) be because of society wide consensus. Churches will have had a lot of time to formulate how to serve the needs of their faith and community.

  47. belvarine

    Some socialists on social media are trying to spread a narrative where capitalists think the economy is more important than lives and want to lift the lockdown immediately, and it’s only socialists who are standing up for the importance of saving people. Top economists aren’t a perfect stand-in for capitalists, but it’s still pretty clear that they’re wrong.

    Indeed these socialists are mistaken. However, the socialists trying to spread a narrative where capitalists think the economy is more important than lives and want to lift the lockdown immediately appear to be correct.

    1. DavidFriedman

      Putting the question as “is the economy more important than lives” is either fuzzy thinking or demagoguery. If you could save one life at the cost of the economy collapsing, should you? Surely not — if only because indirect effects of the economy collapsing would include the loss of many lives. If you could save a million lives at the cost of the GNP being .01% lower, surely yes.

      1. DaveK

        Indeed. The narrative seems to be that such people are only concerned with their person stock portfolios.

        Concerns about the economy are genuine, and and economic consequences will hurt poor and middle class people more then rich people (unless you measure in trivial ways)

        1. Hoopdawg

          economic consequences will hurt poor and middle class people more then rich people

          This is obviously true. Also, obviously unnecessary, we live in the wealthiest societies in history which could make sure everyone survives (economically, the sick will of course still die or see their health deteriorate) the pandemic without significant harm. If swaths of people do get harmed, it’s by choice. A choice unrelated to (necessary) counter-pandemic measures, but related to who is currently in power.

          Now that I think of it, this is probably a much clearer case of “only socialists (…) standing up for the importance of saving people” than a factual discussion about the economic effects of lockdowns could ever be.

          1. Clutzy

            This is not so obviously true because the unemployment effects will be extremely hard to separate afterwards. Some poor and middle class people will be able to regain employment, i expect many in the middle class will be able to obtain labor at a less prestigious and less well paying job quickly IF they want to. Indeed, a laid off attorney or accountant would have no trouble getting a job in amazon procurement right now. But that is lower compensation than unemployment benefits. As we saw with the 2008 extension of benefits, this clearly happened. But the long unemployment creates a loss of human capital that caused long term effects where those middle class people never got back into the job market.

            In addition some poor will likely never get back to work if we keep supplementing them, that is why we have amended the rules of welfare over and over.

  48. atticade

    That last graph is really hard to read. Seems like a lot of those colors are really close to one another. Anyone have a better (high contrast, or labelled) version?

  49. Bugmaster

    Regarding the economy, my prediction is that the pandemic will greatly accelerate our pre-coronavirus economic trends. I expect to see the USA well on its way on becoming a wholly owned subsidiary of China in the next six years. We’ll probably join the Belt and Road initiative in some form, extend special trade partner status to China, clamp down hard on anti-CCP sentiment in the media and social networks, etc. We might even officially declare Taiwan a Chinese province, although grand gestures like these might take longer. In any case, expect China to greatly accelerate the pace at which it buys up key pieces of American real estate and business market share.

    1. matkoniecz

      I expect to see the USA well on its way on becoming a wholly owned subsidiary of China in the next six years.

      Are you ironic here? Because if that is serious then it seems a ridiculous predicion.

      1. Bugmaster

        How so ? Italy had already joined the Belt and Road initiative, so it’s not an unprecedented event by any means. It looks like France will allow Huawei to build their network infrastructure. China already wields a significant amount of control over the US media, so they can swing public opinion if they play their cards right. I agree that “wholly owned subsidiary” is perhaps hyperbolic — meaning that yes, it will happen eventually, but not in six years. That’s why I added “well on its way” in front of it.

        1. HeelBearCub

          Does “wholly owned subsidiary” ever cease to be hyperbolic? Or do you mean this literally?

          1. Bugmaster

            Ok, granted, it’s always a little hyperbolic 🙂 But what I mean is something like Hong Kong, where the country is technically autonomous, but even more technically they have to run every major decision past the CCP.

          2. matkoniecz

            Congo Free State and Leopold II of Belgium?

            BTW, Congo Free State is a real “gem”.

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

            The baskets of severed hands, set down at the feet of the European post commanders, became the symbol of the Congo Free State. … The collection of hands became an end in itself. Force Publique soldiers brought them to the stations in place of rubber; they even went out to harvest them instead of rubber … They became a sort of currency. They came to be used to make up for shortfalls in rubber quotas, to replace … the people who were demanded for the forced labour gangs; and the Force Publique soldiers were paid their bonuses on the basis of how many hands they collected.

          3. HeelBearCub

            @Bugmaster:
            What set of steps do you imagine happening that lead to the US being formally under the sovereignty of China? That’s the status of Hong Kong.

            That’s why Hong Kong isn’t truly independent, because their independence is only contingent on Chinese treaty obligations to the UK, who formerly took control of Hong Kong via treaty with China.

            Or do you really just mean “highly influenced by China with some treat pay obligations”, similar to the relationship the US enjoys currently with many countries?

          4. Bugmaster

            @matkoniecz:
            No, that’s why I said “well on its way”, not “completely there”. Specifically, here’s some of what I expect to see (in no particular order):

            * Media/social network censorship of any negative coverage of China (already happening to some extent)
            * The US joins Belt and Road officially, or
            * The US does not join Belt and Road officially, but begins leasing major ports and resource operations to China anyway
            * China owns controlling stock in at least 2 of the top 5 US corporations
            * US government routinely and officially praises China for their (allegedly) effective government policies
            * US government either officially recognizes Taiwan as a province of China (as I said, above, somewhat less likely), or
            * US government clamps down on any mention of Taiwan whatsoever
            * 10 or more US Senators receive the majority of their campaign contributions from China
            * Tariffs on China are revoked, favorable trade policies are enacted instead
            * Consulting with official CCP representatives becomes a routine SOP in most major corporations, especially media/entertainment (already happening to some extent)
            * College curricula adjusted to include classes on US/China relations, Chinese history, etc., presenting generally favorable coverage of the CCP
            * Some version of Chinese shoots up into the top 3 list of America’s most commonly learned foreign languages (for non-native Chinese speakers, that is)
            * Huawei or some other Chinese company provides the majority of the US telecom infrastructure (or, at least, is contracted to do so — infrastructure takes time to build)

            I could go on, but you get the gist, I think.

          5. matkoniecz

            “well on its way”, not “completely there”

            OK, that still seems really unlikely but has some chance of happening.

          6. Lambert

            > US government clamps down on any mention of Taiwan whatsoever

            Sounds like a good way to get the unwanted attention of the ‘2nd protects the 1st’ crowd.

    2. DaveK

      Why? The general political sentiment seems to be the opposite- that this has proven we should be less dependent on China.

      I understand practically this has probably increased China’s relative economic power, but it would seem that would likely accelerate the political will to fight back.

      China is still dependent on the USD having value. A US economic collapse would also hurt China badly.

      1. Bugmaster

        I agree that we should be less dependent on China, but I don’t see it happening. The US is headed into a major depression the likes of which have not been seen since the 30s; meanwhile, China is poised for major economic recovery and expansion — due in part to their general disregard for human lie and a penchant for slave labor.

        1. eric23

          Nonsense. The US economy will recover quickly once coronavirus is gone. Nearly all the people unemployed now will go right back into employment once social distancing is ended.

          China, on the other hand, has benefited massively from international trade in the last 30 years, which effectively caused wealth to diffuse from the West to poorer countries. But now that China is middle income, it can no longer grow much by this method. Also China has about 15 years left in the demographic optimum (many people of working age and few old or young) before it has a massive number of old people and fewer workers to support them. So they will be facing massive problems in not too long.

          1. The Nybbler

            Nearly all the people unemployed now will go right back into employment once social distancing is ended.

            Doesn’t the bailout bill make unemployment pay better than employment, at least for four months?

          2. albatross11

            eric23:

            Maybe, but that’s sure not obvious to me. A whole lot of small consumer-facing businesses are going to have gone two or three months with little or no income. Many will be in arrears on rent, loan payments, taxes, health insurance premiums, etc. Many of their employees will also now be in arrears on payments, will have run up debt to buy groceries. etc. Others will have moved on to other jobs and may or may not come back.

            After the lockdowns, there will still be people reluctant to be exposed to those businesses. Eating out, going to a bar, getting your hair/nails done, getting your morning coffee, going to a pool hall or bowling alley or theater or concert–all those are things that the most susceptible people, and those who care for highly susceptible people, will be reluctant to do. Demand will fall off quite a bit.

            End the lockdowns, and those businesses are still in trouble. They’re behind on all kinds of bills, their employees are also in financial trouble, and they have fewer customers and less business than they did before the shutdown.

            Maybe that will all just work itself out seamlessly, but I sure don’t see why that’s the way to bet.

  50. ermsta

    I would be keenly interested in any help finding raw all-cause mortality data for the purpose of estimating excess deaths during the pandemic — even if that help is just having better google fu than I do. Most of the data I have found is aggregated by year, which is too coarse (and updated too rarely) to be useful. I have a preference for US data but am also interested in non-US data. Ideally data would be broken down by sub-national level and by cause of death but this is not necessary.

    For the US, I have found monthly data (which is still a bit too coarse), but the most recent available is 2018. The best data I have found is weekly data for the UK but it is aggregated by date of death registration and not date of death, which for various reasons causes systematic bias. However I did find something interesting in it: in late March, approximately 1.5 times as many death certificates refer to covid-19 each day as there are official covid-19 deaths.

    1. zzzzort

      Not the most obvious source, but this page has downloadable total mortality on a weekly basis.

      But note there is a lag, so the most recent few weeks aren’t trustworthy. The ny times had a good interactive, but just for the new york area

      1. ermsta

        Thanks for the link. Unfortunately that is specifically pneumonia and influenza, and I am looking for all-cause mortality. I might still find something to do with it if I can find nothing else.

        1. Douglas Knight

          It has three columns: influenza, pneumonia, and total deaths.

          Also consider Euromomo, which is up-to-date (with provisional data for the last, relevant, 4 weeks) all-cause mortality, but which is heavily transformed and only available as graphics. Where is it getting its data? Probably the raw data is available from the individual countries, whereas the above CDC link might be the only window into the CDC data.

          1. ermsta

            Ahh, thank you! (and zzzzort) I must have glanced over the “total” column thinking it was just the sum of the influenza and pneumonia columns. I hope I can make use of this US data (although I would still appreciate any other sources people find).

            The euromomo data is a good find but tantalizing how they clearly have the data but aren’t releasing it. Maybe if I ask nicely they’ll just let me have it? Hm.

            The quite high variation in deaths due to the flu from one winter to another is going to make it rather harder to create a suitable model. The strong correlation within a year but low correlation across years drastically lowers the “effective” amount of data, and will make the error bars huge.

  51. Matt M

    Re: The poll of economists.

    I think the question is phrased in a sneaky manner that’s designed to produce the result we see. (As is often the case with these things.) Allow me to repeat it:

    Question B: Abandoning severe lockdowns at a time when the likelihood of a resurgence in infections remains high will lead to greater total economic damage then sustaining the lockdowns to eliminate the resurgence risk.

    The italics are my own.

    I would submit that the “lockdown skeptics” (a group in which I include myself) dispute whether the italicized portion necessarily describes where we are today.

    That said, if a genie came down and told me, for certain, that abandoning the lockdowns today would lead to a resurgence of the disease and an environment of which all of the former dire predictions became true, and would require either starting the lockdowns over again from scratch, or having the entire world face NY-like waves of disease and death, then yes – I’d favor keeping the lockdowns going.

    But many of us are uncertain that describes the reality we are currently in.

    For a sports analogy, it’s like asking American football coaches something like “If your opponent was going to blitz the quarterback, should you call a screen pass (for non-American football fans, a screen pass is a play known to be very effective against a blitzing defense, but risky otherwise)?” noticing that most coaches say “Yes!” and summarizing the results of “Coaches agree that more screen passes should be called!” No – they just agree that in a specific hypothetical circumstance wherein a screen pass would be expected to be the best call, it is what should be called.

    1. ltowel

      I sort of agree with you and sort of don’t – I think we’re so fucked that these lockdowns aren’t saving any lives, and just stretching the inevitable deaths that will happen out – hence why I think that they should end.

      “Why call for a screen on third and long when you’re gonna get strip sacked anyways”

      1. DaveK

        “I sort of agree with you and sort of don’t – I think we’re so fucked that these lockdowns aren’t saving any lives, and just stretching the inevitable deaths that will happen out ”

        I really have hard time even guessing what your reasoning is here, as well as the reasoning the previous poster is using to guess the ending the lockdowns within a week wouldn’t make a substantial difference.

        1. ltowel

          That’s fair – I’ve definitely been drinking too much during this (including during this post), in a way that will certainly make my reasoning incomprehensible if not worthless.

          I basically think that those who are harmed by these approaches are consistently ignored, and I’m bothered that nobody even seems to be thinking about or considering the ‘end’ of this approach when I’m an alcoholic, my grandfather has died from a heart attack because he can’t golf, the person around the corner is killed by their abusive partner, etc, etc. I feel incredibly ignored, and don’t trust the records of the people proposing eternal lockdown as a solution.

          I might be wrong, but the only people publicly espousing my fears in the ‘mainstream’ are fucking idiots – it’d be nice to see them expressed and respected.

      2. Matt M

        I don’t disagree with anything you said.

        I think there are two plausible reasons to oppose lockdowns… one is basically “they weren’t necessary in the first place. Two is basically “they won’t do any good because we’re eventually going to need to go ahead and get herd immunity anyway.”

        If either of those scenarios are true, the lockdowns are doing more harm than good already, right now, and should be ended.

        1. anonymousskimmer

          We never needed herd immunity for SARS-1 or MERS. The principle reason we need herd immunity for other common diseases is that people and animals never bothered to nip them in the bud (as we did smallpox and are doing to polio).

          Herd immunity is far safer when vaccine derived.

          1. Matt M

            Herd immunity is far safer when vaccine derived.

            Yeah, obviously.

            But the question becomes, if a vaccine is 1+ years away (as almost everyone believes it is), is it more harmful to keep the entire world shutdown for a year, or to just let the disease go and have ~0.1% of the population die or whatever would happen?

            Anyone who favors “keep everything locked down until vaccine” should be required to specify what they believe the time cutoff would be before it stopped being worth it? 3 months? 1 year? 2 years? 100 years?

          2. anonymousskimmer

            False dichotomy.

            At this point I might be more in favor of literal sanitation police than continued lockdown (at least past the first hump). As well as mandatory remote work for those jobs that can function that way, and shift work for those jobs that can function in shifts (with sanitation between shifts).

            Targeted lockdowns still seem like a good idea to me going into the future.

          3. keaswaran

            “is it more harmful to keep the entire world shutdown for a year, or to just let the disease go and have ~0.1% of the population die or whatever would happen?”

            Let’s assume that 0.25% of the world population would die if the virus were just left unchallenged. (That would represent a 50% infection rate and 0.5% fatality rate.) Let’s assume that the average victim has 10 years left to live, and that people that get the virus and don’t die have no loss of quality of life. Let’s assume that the lockdown removes 10% of the average value of life for the time it is in place. Then a lockdown of half a year would be justified if it could prevent most of these deaths.

            If we don’t have to sustain the full lockdown until vaccine, but only until infection rates are low enough for testing and contact tracing to continue the protective work, then it looks like we’re fine.

            If you disagree with some of the numbers I used, then we may end up with a somewhat longer or shorter time horizon. (I’m most skeptical about the claim that 49.75% can get the virus and have no loss of life value – from my friend who had it, it sounds like the three weeks that she had it were far worse than three weeks of lockdown.)

    2. DaveK

      I think your argument cut both ways.

      If we are at a point where the epidemic hasn’t even peaked, it’s techincally true that relaxing restrictions now won’t lead to a resurgence.

      But if the surveyed economists are answering that question literally, a major factor in their reasoning may be that relaxing restrictions prematurely would ultimately lead to more time spent under lockdown.

      As a very libertarian leaning person, I do hate the current situation. However I acknowledge it may be the lesser evil, as pandemic mitigation is probably what minarchists would say falls under the few limited legitimate functions of the state.

      I would much prefer to “get it over with”. In other words, I would prefer lockdowns that lst sequentially longer rather then periodic lifts that ultimately mean more time spent under lockdown.

      I understand there may be an economic/sustainability argument that the nation has to do the latter. I think the truth is however no one can be sure of the ultimate consequences of lockdown, as it’s essentially an unprecedented experiment.

      I do question the value of the surveyed economists guesses if the length of the lockdown as a factor doesn’t yield significantly different estimates.

      1. albatross11

        I think we have to work out how to relax parts of the lockdown sooner or later, because we can’t function for a year with like half the population unable to go to work.

    3. Purplehermann

      I’m not sure all the economists were measuring the question from an economics point of view either

  52. orthonormal

    Re: the second derivative, any popular distillation of that happy news needs to lead with the fact that until* the daily cases decline significantly in your area (not just plateau), the risk of getting infected if you slack on your social distancing is higher than ever.

    Now isn’t just premature to declare victory to the general public, it’s the exact worst time.

    * Of course, number of confirmed cases lacks true number of cases because people take a while to get symptomatic enough to get tested, and we’re too dumb/too low on tests to do contact tracing. But still.

    1. DaveK

      Maybe. But that has to be balanced by other psychological factors.

      People will be more likely to take better precautions if they see the situation as temporary. If the length of the time is indeterminate, many people will do a different type of risk assesment. Also, with the bombardment of bad news, people need some positive news, as anxiety levels and spirals also impact physical health.

  53. AnteriorMotive

    Isn’t there a simpler-still explanation for the preponderance of bat-linked diseases? Bats can live in huge colonies of over a million members. This is the perfect environment for the spread of disease: plenty of potential hosts for the virus to jump to and from. A new virus infecting a herd of antelope would infect all ten members, and then go extinct once it had no new hosts to jump to, now that the herd has acquired herd immunity.

    The only other mammal with social groups that large, (who we can expect to be similarly disease-ridden), is humans.

    1. Richard Meadows

      Yep. There’s a great Matt Ridley article in the WSJ (free version here) which looks at this:

      There are good reasons why bats spread so many viruses. Bats are long-lived mammals, like us, and live in large crowds, like us—ideal for spreading respiratory infections in particular. One bat roost in Texas houses 20 million bats at certain times of year, a concentration of mammals paralleled only by people in cities. There are lots of different species—one-quarter of all mammal species are bats—so they have lots of different viruses. And they fly, carrying diseases long distances, allowing viruses to indulge in “host-shifting” between bat species. This especially suits viruses that can “recombine” with related strains, like coronaviruses.

      1. Le Maistre Chat

        Bats are long-lived mammals, like us, and live in large crowds, like us—ideal for spreading respiratory infections in particular. One bat roost in Texas houses 20 million bats at certain times of year, a concentration of mammals paralleled only by people in cities. There are lots of different species—one-quarter of all mammal species are bats—so they have lots of different viruses. And they fly, carrying diseases long distances, allowing viruses to indulge in “host-shifting” between bat species.

        Wow, Today I Learned.

        1. keaswaran

          I’m not sure if this is one of the ones in the caves of hill country, or if it is the urban bat colony that lives under the Congress Ave bridge in Austin. If you’re ever able to travel to Austin again, then some time between March and October, you should definitely go downtown just before sunset to watch the bats come out. It’s an amazing sight, and a great social event too.

  54. orthonormal

    Former Wisconsinite. Re: voting by mail in Wisconsin, the Republicans’ calculus there was that many poll workers in cities would stay home, and indeed Milwaukee went from 180 polling locations to just 5. For the entire, very Democratic, city. People stood in very long lines, braving the rain as well as COVID-19, to vote in Milwaukee and Green Bay. Probably not nearly as many people as would have voted otherwise.

    Voting was not as impacted in redder, less urban areas.

    Moreover, it’s not the presidential primary they cared about but the state Supreme Court election (yes, they elect Supreme Court judges to ten-year terms there)- the same state Supreme Court that issued the ruling letting the election go forward, which was upheld by the U.S. Supreme Court.

    1. Polycarp

      The Wisconsin Supreme Court did issue an order that let the election go forward (Wisconsin Legislature v. Evers). But that ruling was not (as far as I know) upheld by the U.S. Supreme Court. The U.S. Supreme Court order was issued in a different case (Republican Nat. Com. vs. Democratic Nat. Com.), which had to do with the date by which absentee ballots would have to be postmarked. See the short blurb in SCOTUSblog.

      1. Jacobethan

        Right.

        The US Supreme Court has no jurisdiction over cases arising under Wisconsin law. The Wisconsin Supreme Court is the final arbiter of what the Wisconsin constitution defines the governor’s emergency powers to be. The two cases were utterly separate and involved legal issues of wholly different substance and scope.

        1. HeelBearCub

          Well, it’s not quite as cut and dry as that. SCOTUS can over rule state supreme courts about their own election laws, and who has what powers, precisely when they feel like it.

          Usually in a fairly principled way. But not always.

          1. Jacobethan

            Only if a federal question is somehow implicated. Obviously state statutes are challenged on their constitutionality all the time, and there can be questions that arise out of conflict between state and federal law. But if one thinks a state court has misapplied state law, the recourse is through the state appellate system.

            There are instances where a federal court can hear purely state-law claims, diversity jurisdiction (i.e., where the parties are in different states) being the most obvious. But those exceptions don’t apply to the case at hand. SCOTUS does not and cannot act as a roving arbiter of state constitutional law.

          2. HeelBearCub

            There were Federal implications in the Wisconsin election in much the same way there were Federal implications in Bush V. Gore. There were primary contests for federal offices, which count just the same, if I understand United States v. Classic (1941) .

          3. Jacobethan

            Bush v. Gore was a 14th-Amendment Equal Protection case. It wasn’t Bush claiming the Florida Supreme Court had misconstrued Florida law.

            The question addressed in the Wisconsin case was whether the governor’s emergency powers under the state constitution extend so far as to allow him to override/suspend statutes, or only to do so with regard to “administrative rules.” This is a really fundamental separation-of-powers issue in terms of the basic organization of state government, with no obvious federal jurisdictional hook.

            It’s certainly true that US law constrains the conduct of elections in many ways. Most relevant here, perhaps, is that the Constitution provides that the manner of voting in both congressional and presidential elections (since interpreted to include primaries, as you rightly point out) is to be determined by “the legislature” of each state. There is some wiggle room as to what exact entity might count as “the legislature” (e.g., an independent commission), but it’s pretty clear that a governor acting in direct contravention of the actual legislature’s wishes is definitely not it. So if the ruling in RNC v. DNC had gone the opposite way, that could conceivably have formed the basis of a GOP appeal to SCOTUS. I don’t know, though, if the issue was raised in the arguments before the Wisconsin Supreme Court; in any case, the court in its ruling chose to focus only on the state-law question.

          4. HeelBearCub

            And if a liberal SCOTUS had granted cert on whether a pandemic constituted a threat to rights under the 14th amendment and decided that the Wisconsin governor was correct to halt the election due to this, well, who would be able to stop them?

            Like I said, usually principled. Not always.

          5. HeelBearCub

            … and speaking of not necessarily principled.

            Republicans, meanwhile, successfully asked the Court to impose a new limit on voters — that absentee ballots had to have been postmarked by April 7 or else they would not be counted.

            As it turns out, the post office does not place any postmark at all on some mail, such as ballots that are sent via metered mail. In other cases, ballots had postmarks which merely said that the ballot was mailed at some point in April of 2020, without giving a specific date.

            One of the striking things about the Supreme Court’s order in Republican is that the majority opinion makes no mention of the standard that normally applies to stays pending appeal, nor does it acknowledge that lower court judges typically should be treated with a degree of deference in emergency stay proceedings.

            So the 5 conservatives who control SCOTUS fubarred something they probably can’t or at least won’t undo because they didn’t follow the normal principles involved.

          6. Jacobethan

            To be clear: I don’t think the quality of legal reasoning in either the per curiam opinion or the dissent in RNC v. DNC is terribly high. I think both sides were working under extraordinary tiime pressures and produced somewhat shoddy work that looks a bit like a first draft.

            To say that “the majority opinion makes no mention of the standard that normally applies to stays pending appeal,” though, is facetious. The opinion is, for better or worse, thoroughly premised on the Court’s precedents regarding the specific sequence of events that brought about this appeal, namely eleventh-hour changes to election procedure ordered by lower federal courts. The whole dispute between the majority and the dissenters turns on the majority’s desire to follow the “normal standard” that’s been established around the distinctive considerations involved in last-minute changes to electoral procedure.

            Ginsburg’s dissent, by the way, makes a compelling case that this is not the time to be curtsying to “normal standards.” But she also manages to insert an obviously wrong account of the precedent on which the majority relies, which vitiates not the overall moral force of her position, but much of the specific legal reasoning she depends upon.

            As I said, not a case that does much credit to anybody.

  55. J

    I’m predicting a surge when we get to 10-20% of population out enjoying themselves because they’ve already had it, and everyone else is sick of being at home.

    Also my brother is probably just getting over it, but nobody will test him, so he doesn’t even know if it’s safe to go out at all, much less volunteer for hazard duty. We really need antibody tests!

    1. keaswaran

      My understanding is that most antibody tests have something like a 2% false positive rate. Given that the base rate for “has been infected” appears to be substantially below 10% even in the worst-hit areas, this means that antibody tests don’t give you very clear actionable information, unless you had a disease with the right symptom profile at the right time, to add some more information beyond the base rate.

      1. The Nybbler

        Given that the base rate for “has been infected” appears to be substantially below 10% even in the worst-hit areas

        This is not a given.

  56. Edward Scizorhands

    The Tumblr post says that Clinton wouldn’t have done better “because up until approximately the third week of March, no one in power was taking this seriously.” But even in Trump’s White House, there were people warning about it.

    Azar tried to talk to Trump about it on January 8th, instead of vaping. On February 5th he wanted a $2 billion order of PPE.

    Navarro warned on January 29th that a serious pandemic hit would cost us $3.8 Trillion and if there were just a 1% chance of it happening it was time to spend billions now. (A once-a-century event already has a 1% chance of happening in a normal year, and a year where there is a novel virus moving through other countries pushes that up even more.) And on February 23rd he said “This is NOT a time for penny-pinching or horse trading on the Hill.” (Emphasis in original.)

    I would be pretty confident in George W Bush, too: https://twitter.com/PatrickRuffini/status/1248600661035548674

    1. tvt35cwm

      This is right. Navarro tried and he was ignored. The buck stops on the president’s desk.

      All those key bureaucratic posts left unfilled for years, all the rest of it. Down firmly to one person’s whim.

      The USA needs a career (non-elected) civil service and to remove the appointed positions. And limitations on presidential powers.

      1. Doctor Mist

        Navarro is the boy who cried wolf:

        In context, however, much of the blame shifts to Navarro himself, and to his fellow economic nationalists in the White House. Their constant reliance on “national security” and “national emergency” hysterics caused others in the Trump administration (and the country more broadly) to tune them out. As one White House adviser put it, “The January travel memo struck me as an alarmist attempt to bring attention to Peter’s anti-China agenda while presenting an artificially limited range of policy options.” In short, when the real China emergency arrived, nobody paid attention to the guy who spent the last three years running around the West Wing yelling that everything China touched was an emergency.

        Given Covid plus China’s obfuscatory, obstructionist, and threatening stances afterwards, I’m a little tempted to think Navarro was right about all of it. But I can’t find it in me to blame people for writing him off.

        (Note that The Dispatch, the source of the article cited, is very far from Trumpist — as near as I can tell they split off from National Review because the latter was too tepid about its Never-Trumpism.)

    2. mtl1882

      There’s no way to know how others would have responded, and whether that change would have made an actual difference. It’s certainly possible that Clinton would have done better, but my intuition is that she would not done anything meaningfully different. (I’m sure she would have acted and certainly spoken differently than Trump in some ways, of course!)

      There is a big difference between being aware of a problem and choosing to take major action to address it. A president gets notified by advisors as to a long list of concerns, and the advisors disagree among themselves, and they eventually decide what to prioritize. (Someone can express concern Al Qaeda is planning a major attack; that doesn’t mean people believe them or that other things don’t seem more pressing). Navarro brought it up, but it is probably true that most people in power were unimpressed and pushed back (I see reports that many thought he was fixated on China). I could see a very similar situation happening under Clinton, with one or a few advisors expressing great alarm, but most of the leadership class pushing back. I don’t know what would have happened. The 2016 Clinton campaign leadership was criticized for operating somewhat in a bubble and not correcting course–not sure how valid that criticism is, but that’s a very common dynamic.

      There is always a major push not to do anything that might disrupt the economy, or at least to believe that anything that threatens the status quo is overblown. I can see the argument that Trump is more sensitive to this than Clinton, but certainly Clinton wouldn’t have been insensitive to it. There was clearly strong resistance to possible overreaction for other reasons, including an aversion to seeming xenophobic or draconian in taking quarantine measures. Being warned just doesn’t equate to taking it seriously, but I have no reason to think this is a Trump-specific thing. And while there were definitely people taking seriously like Azar, it was by no means the majority view in political circles. Trump has to listen to a bunch of conflicting viewpoints and then make his choice in prioritizing. These are ultimately political decisions, and always will be. The same types of mistakes happened in other countries and in various states and agencies. Some were better than others, but it wasn’t clear cut. Most Trump-specific mistakes getting attention are “stupid remarks” that people find inappropriate but were unlikely to have made a meaningful difference in the course of the pandemic. Clinton probably would not have made those remarks. The partisan framing of the matter helped no one (cable news talking about hoaxes to take out Trump, etc.), but it’s hard to say what the culture war would look like if Clinton had won, and those dynamics were in place long before Trump made these calls.

      Every president had a responsibility to take this seriously—it seems that Bush is the only recent president who really focused on it, because he had read a book about the 1918 pandemic. All one needed was knowledge about that event, let alone SARs and MERs. Other pressures and priorities won out–the funding and political will wasn’t there across multiple administrations. As everyone is aware, Bush didn’t spend his presidency actually tackling pandemics or other domestic natural disasters, even though I believe his concern was very real. The people around him saw the Middle East as a higher priority. A lot of people seriously seemed to think pandemics couldn’t happen anymore or were extremely low risk compared to other things. I believe Bush and Obama actually had a pretty good idea of the risks because they have more realistic views of what is within human control than either Trump or Clinton, or their own advisors, but that doesn’t necessarily make them good at governing in a world where people push them in a different direction. Also, while I believe preparation and some other choices could have made a meaningful difference, I still think we’d have an uncontrolled pandemic on our hands no matter who was president. This is a very difficult situation.

      1. Edward Scizorhands

        I don’t think any President would have stopped the virus from gaining a foothold in the US. That would require strict border inspections and even Trump’s were too little, too late.

        But when a trillion-dollar-tragedy gets its odds bumped up to a few percent chance of happening, spending and attention activates. So there would have been more attention paid to PPE production and to test generation early on. They’d never be ahead of it [1], but they would have been much less far behind. I can buy that the test screw-up was entirely random chance, not something that necessarily could have been prevented by a White House without a crystal ball. But the screw-up would have been noticed sooner and other resources brought to bear to attempt to make up for lost time.

        [1] Every President would have, pretty much by definition, underestimated the odds of an American outbreak for a long time, since we know with the benefit of hindsight that the odds were going to turn out to be 100%. I think the latest point where a competent administration could have doubted this was February 21st, when we had the confirmed outbreak in Italy. At that point, it was definitely going to hit Europe and definitely the US.

        1. HeelBearCub

          It’s worth pointing out that Trump’s restriction of Chinese travelers was so little and late that a) it cam after all the airlines stopped flying from China anyway, and b) thousands of people came in anyway, because the came through a different country first.

    3. BBA

      Clinton wouldn’t have done better for a number of reasons, first and foremost being that she isn’t nearly as competent as her online fan club thinks she is.

      In particular, she’d be looking at the aftermath of a Republican wave election in 2018, a Congress even more implacably hostile towards her than the current one is towards Trump, and a bunch of state governments that would not be inclined towards cooperating with the Feds. And it’s an election year and the economy is on the verge of a recession. Those are long odds for anyone.

      1. anonymousskimmer

        A part of the reason for the Democratic wave election (which only netted the house) in 2018 was the previous control of both chambers and the white house by the Republicans (I distinctly recall reading of people voting Republican for Congress because they wanted to balance against the expected Clinton win). Had Clinton come in with Republican controlled chambers there likely wouldn’t have been a Republican wave in 2018. And its possible the Democrats would have regained control of the house (though with a smaller margin), had the Republicans been especially hostile towards her.

        With Clinton we may have had a smaller recession already, and be in a post-recession recovery.

      2. Simon_Jester

        “Clinton wouldn’t have been able to do a better job of managing this epidemic because the Republican Party collectively would have stopped her” may be true.

        But it has interesting implications for which set of politicians the voters of the United States should continue to allow in power if they want ot enjoy luxury goods such as ‘not dying of horrible diseases.’

        Another relevant point is that President Clinton would probably not have deliberately fired or failed to appoint replacements for federal officials who have responsibility for epidemic-handling, or on coordinating on China with epidemic-related problems. Even if Clinton herself had absolutely no more managerial ability than Trump (and Trump has done shit like “sign Defense Production Act authorization and then forget to actually order anyone to produce anything,” as far as I know)… There would be a much more intact and functional system in place to deal with the virus.

        Clinton also probably wouldn’t be telling her voters things that make the CDC people responsible for using fact-based rational methods to fight the virus facepalm and tell people “no that isn’t true” so often. Because Clinton doesn’t have a habit of routinely making shit up and telling it to the public to see if she can make it stick.

    4. DaveK

      To be fair (and this isn’t an argument defending Trump, just a general point)- the POTUS and others are probably presented with a lot of scenarios that is they happened would be disastrous.

      The reasoning “this has a very small chance of happening, but since the consequences would be enormous, we should spend resources on it” that is often used by LW folks doesn’t account for limited resources and political will that have to be divided amongst many different unlikely concerns.

      Now I don’t think this argument applies to coronavirus specifically, because the odds were significantly higher.

      It’s more a thing that people in general don’t factor.

      I remember there was a lot of criticism of Bush and the administration in regards to their unpreparedness of 9/11 in regards to the warning signs. To be clear, I am not suggesting they don’t have blame. Rather, the way it is often presented is by critics is to assemble all the various information/warnings they did have and make it seem as it was incredibly obvious. That doesn’t account for all the other information/warnings people get that don’t pan out.

      I think it definitely suggested a better threat evaluation system needed to be in place, where individual pieces of information from different sources could be correlated and risk assesments be made. And there were some reforms made along those lines, although of course improving such also threatens individual liberties.

      I think most people here should understand what I’m getting at. Learning that there was information that pointed to bad outcomes in hindsight must be balanced against the amount of information, often conflicting, about potential threats and the understanding that sufficient resources can’t be spent on all of them.

      It’s especially problematic because dividing up resources based on likelihood and risk may not even make sense, as one could argue a better strategy would be to very prepared for some scenarios/threats and be unprepared for others, rather then have a small amount of preparation for many which wouldn’t be sufficient to prevent any individual scenario.

      1. mtl1882

        Perfectly said. As you said, coronavirus was a clearer case than many others, but a president can’t possibly just act on every warning—a huge part of the job is trying to sort out conflicting warnings or warnings paired with dismissals of warnings, even among advisors. I tried to make a similar argument above, but didn’t think to make this point, which is very important:

        It’s especially problematic because dividing up resources based on likelihood and risk may not even make sense, as one could argue a better strategy would be to very prepared for some scenarios/threats and be unprepared for others, rather then have a small amount of preparation for many which wouldn’t be sufficient to prevent any individual scenario.

        And if you try to address everything, it quickly becomes way too hard to coordinate the efforts relative to each other. Better to have a coherent focus and an understanding of trade-offs–if you know you’re prioritizing, it’s easier to shift priorities if needed.

        I recently read a book that had a really interesting breakdown of pre-9/11 intelligence issues and the dysfunctional way we evaluate and address threats: https://www.amazon.com/dp/B000FC29LG/ref=pe_385040_118058080_TE_M1DP

        1. albatross11

          The thing to remember is that the president basically can’t do much about a crisis like this when it’s happening. His job is in the years before the crisis arises, when he should be ensuring that the machinery for dealing with this kind of crisis is in place, and that some competent person is in charge of that machinery.

          And of course, the problem there is that crises are by definition rare. A president, governor, congressman, etc., just needs to get through his term in office without catching the blame for a crisis, whereas many measures to prepare for a crisis are going to be expensive, fodder for attacks from the other side, annoying and tedious to deal with, etc. And indeed, it’s probably pretty hard for the president or governor to know for sure whether his health apparatus is well-prepared for a pandemic without actually having one, or whether his army is well-prepared for a war without having one, or whether his state disaster relief apparatus is well-prepared for an earthquake without having one, or whatever.

          1. Edward Scizorhands

            One big reason to always react seriously to a new disease (at the government level — you don’t need to put in locks at the populace level right away) is that you find out where you have gaps.

            There were after-action reports for the Ebola outbreak where the Federal government looked back at its own response and said “here are the gaps that would have really hurt us had this been much worse.”

        2. Simon_Jester

          Interestingly, a lot of the things the US could have done early to prepare for this crisis are things that would NOT be overreacting and would remain useful even if it all blew over.

          For example, mobilizing US industry to mass-produce PPEs and test kits and respirators in January would potentially save lives and win the US a lot of goodwill overseas in countries affected by the virus, even if it never got to the United States directly, because we could then be the “Arsenal of Health” or whatever.

          Reaching out to local and state governments and working with them to update their antivirus plans would help ensure that in any future pandemic, local communities have good plans they can easily pull off the shelf and implement to protect themselves.

          Working to spread accurate information about the virus and why it is dangerous, as opposed to bloviating and lying about it and acting as if it literally couldn’t reach the United States, would help to ensure the public remained aware, and potentially reduce the risk of it coming to us in the first place by making sure people coming into the country are taking quarantines seriously.

          Sure, President Trump (or Clinton) would have almost certainly been out of their minds to declare a full national shutdown in January in an attempt to fight the virus at that time, effective though such a strategy might have been. But there is so very very much that could have been done, and wasn’t done, that no matter WHO failed to do it, that person really ought to be condemned for their inaction.

          1. mtl1882

            There are definitely things that could have been done better; I just don’t think it would make a big difference in where we are right now, which is what many people are trying to argue, or that the president is the best person to be doing them. A president can get people to focus and take things seriously, but if he or she is not willing to say things are very serious, just reaching out to local communities and issuing guidelines just-in-case often does very little, because no one pays attention. We had plenty of plans we could have used. That’s a job for other agencies that shouldn’t need much involvement from the president unless there’s a need to mobilize and raise alarm. The agencies themselves, which had the most responsibility for those things, were mostly unconcerned, and that is where the ball was mainly dropped, and all the pressures were against using the presidential pulpit to alarm people. I don’t think Trump would have been “out of his mind” to raise the issue of some sort of shut down at the time, but most people would have *thought* he was, so it wouldn’t have gone very far.

            I do think ramping up PPE production would have been a really good thing that would have made a difference, but apparently we don’t have like any machines in the U.S. that make the required material for N95 masks, if I understand this correctly. Trump could have, and I would even say should have, ordered emergency construction of such a machine and put up government funding to cover the costs, and put industry to work on it. But that would be the equivalent to declaring this a major crisis that would disrupt everything, and the whole point was no one was ready to to acknowledge this scenario. It would have prompted extreme backlash, and could not be done as a quiet back-up plan (we still seem to be having trouble getting some of the basic practical supply manufacturing stuff going, because it disrupts business as usual). It required extreme action, and also revealing how little equipment we had.

          2. Edward Scizorhands

            The defense of Trump I got a few weeks ago was that, by not addressing the virus or advising people to do anything, he was preventing a panic.

            Now I hear that no one would have listened to him and that’s he powerless and impotent.

          3. mtl1882

            The defense of Trump I got a few weeks ago was that, by not addressing the virus or advising people to do anything, he was preventing a panic.

            Now I hear that no one would have listened to him and that’s he powerless and impotent.

            There’s a difference between thinking Trump did a great job and thinking he couldn’t have made a big difference. I do think Trump was trying to avoid panic, under the hope that this was addressable, and with almost everyone around him thinking the same way. I don’t think this was the right choice, and I think there was some denial involved (rather than understanding the seriousness and deciding to prioritize avoiding panic), but I think attempts to get people to take it seriously would likely have failed. That doesn’t necessarily mean he should not have done it anyway, and at least tried. I’m not saying he should have incited panic, but tried to get people to take it seriously and prepare them for actions that might happen–this would definitely have resulted in some panic, but well worth it, IMO. He had the power to break the group think, and if he understood the risk, he probably should have done it.

            But Trump’s influence is limited and easily presented as sinister or goofy. Freaking out about the virus would have been easy to portray as “crazy Trump” or xenophobic/authoritarian Trump, both by the opposition that is always waiting and by his economy/stability-concerned advisors. It would probably have been ineffective, or even backfired, for him to have personally raised an alarm if the rest of the “establishment” or leadership/media class was not on board. They would have worked overtime to dismiss him and the threat, and then it would have been even harder to reverse course and coordinate once they were convinced it *was* serious. It’s already been an awkward reversal. (Someone also pointed out that at this time, Democratic primaries were going on. It would have been so easy for even people not particularly focused on Trump to see this as an attempt to distract people from the message and turning out.) Some people would have listened, but a lot of people would not have, and the most influential people would probably have been in the latter group. There were major screw ups, but they happened largely in concert, due to long-entrenched norms in the leadership class that make me doubt the president could have made a difference. We weren’t in a good position to respond to this.

          4. Clutzy

            Indeed, the biggest problem with the anti-Trump theory of C19 is that if Trump had been more reactive than the media generally, he would have been attacked and “discredited”.

            Trump could have done better, but every instance that he could have done better would have been him acting opposite the institutional consensus.

          5. EchoChaos

            @mtl1882

            And note that the places where Trump was ahead of elite consensus (e.g. cutting of travel to China in January) were places that the Democrats DID criticize him.

            His reassurances were mostly repeating things that people like Fauci were saying at the time, which was “we have this under control”.

            I understand why they were saying that. We had experience stopping SARS from entering the US in a big way, so it was plausible that we could also stop COVID-19.

          6. anonymousskimmer

            Who gives a crap if the media craps on a President? Whoever set up the antagonistic (and protagonistic wrt Fox) relationship between them, it’s the current situation, and everyone knows this.

            What matters is how the public views him. Specifically the part of the public that isn’t already strongly polarized.

          7. Edward Scizorhands

            Who gives a crap if the media craps on a President?

            Trump does.

            If you had asked me during the 2016 election “Which candidate would do what he thinks is the best course of action despite the media” it would have been “Trump, of course.”

            But apparently the prospect of doing the right thing and made the libtard media out to be complete fools was just too much winning and he had to pass it up.

          8. mtl1882

            Who gives a crap if the media craps on a President? Whoever set up the antagonistic (and protagonistic wrt Fox) relationship between them, it’s the current situation, and everyone knows this.

            What matters is how the public views him. Specifically the part of the public that isn’t already strongly polarized.

            It matters because they have a huge impact on how the issue is viewed, and what gets momentum. Without any media support, such a major effort would likely have failed. Trump certainly is willing to go straight to the people sometimes and ignore the media, with some success, but this is usually more on narrative stuff, not things that require actual effort and coordination with others. And in this case, he would have had way more people after him than usual, because business/economy-focused republicans would have come after him hard. The public is unlikely to believe things are that dire based on Trump’s belief alone, even those receptive to him. They want to believe nothing is wrong, no major changes are required. If they had been concerned about this beforehand, if it had been a hot button issue where some disruption was desired in some quarters, like tariffs, that would be one thing. That had a history of support, and other experts would have supported it, even if they were in the minority. But almost no one was ready to talk about the pandemic. I’m not saying the problem was Trump being afraid of the mean media—that’s nothing new for him.

  57. eqdw

    I’m surprised by this, because I would have expected mail voting, as opposed to booth voting, benefits people with good executive function who are familiar with doing things by mail – ie older, richer people, ie Republicans. It would appear that I am wrong.

    I am not here to argue, merely to inform. I don’t represent the following as true, I’m only relaying that some people think it’s true

    I have spoken to like four Republican state senators, mostly in MN and TX, and they all seem to be strongly convinced that there are ongoing Democratic party operations to file fraudulent votes on a mass scale via mail-in ballots. They seem to believe the primary mechanism of action is to use the voter registration of elderly people who have since died, and file votes by mail for those individuals.

    Is this true? I don’t know. Probably it is at the margin, just because the US is massive and so every one-in-a-million thing you can think of happens _somewhere_. But I can say that these currently elected politicians are utterly convinced that it is true. Their opposition to vote by mail is not out of stupidity, and it’s not out of some scheme to disenfranchise voters. It’s out of a sincerely-held concern for the validity of their elections.

    1. DeWitt

      No, really, just to reiterate my earlier question: why should anyone care whether or not people hold these concerns genuinely? Can’t we check whether or not they’re valid concerns, or at least the extent to which they are true, all without checking if our opponents are lizardmen or not?

      1. mitv150

        We should care because it determines how we shape our own arguments. Of course, it does not / should not lend any additional weight to the actual veracity of the argument.

        Situation 1: Professed concern of Party A is genuinely held, Party B believes it is genuinely held. Party B can reasonably proceed by checking whether professed concern is valid and marshalling appropriate evidence.

        Situation 2: Professed Concern of Party A is a front for True Concern. If Party B addresses only Professed Concern, no progress will be made because proving that concern invalid will never shift Party A’s position. In this situation, it is in Party B’s interest to spend more time addressing True Concern.

        Situation 3: Professed Concern of Party A is genuine, Party B believes it is a front for True Concern. Party B, in this situation, is unlikely to behave as in Situation 1, because, if they believe the situation is more akin to situation 2, they will tailor their behavior appropriately. Thus, Party B will spend their time and energy addressing what they think is True Concern, and no progress will be made.

        In the present context, the left* spends more time denouncing the voting concerns of those on the right as being about disenfranchisement, rather than focusing on proving them false. Typically, the left* quickly states that voter fraud concerns are clearly overblown and then spends a bunch of time explaining why its all just a cover.

        If the right’s voting concerns are indeed based on attempted disenfranchisement, this may be the correct approach.

        If, however, the right is genuinely concerned about voter fraud, the correct approach is to provide evidence that voter fraud is not an issue and to work constructively on ideas that might satisfy the right without causing disenfranchisement.

        *the “left” here refers to the general theoretical monolithical left, and not to any person specifically in this discusssion.

        1. DaveK

          That doesn’t take into account what I think is the most likely scenario. People tend to develop True Concerns about things that have actual multivariant concerns. If the actual, initial motivation is disenfranchisment motivated by pragmatic power concerns, but the expressed motivation that gets spread and becomes a True Concern is resistance to a plot by the other party, that’s a different scenario.

          It’s not that stating the unsaid concerns will help. It’s that addressing the True Concern that is expressed won’t help either because there are additional motivations that motivate said True Concern subconsciously or for complex reasons, and people will still hold onto those motivations, possibly subconsciously, and conclude the opposition arguments to adress the True Concern are insincere.

          This also underestimates the degree to which both sides distrust the other side. It is at the point where both sides true beliefs are that the other side is inherently evil, manipualtive, and untrustworthy, thus anything they say must be untrue and at best a partially true statement that conceals the fullness of their actual evil agenda.

      2. Corey

        It can be difficult to believe people hold the concerns genuinely, because they don’t stand up to even the most cursory examination. Or even just asking “How?”

        In this case, besides the ways it would be detected after the fact, how would anyone keep an operation of the necessary scale secret? Lots of people of all political persuasions are watching. The candidate and his wife are not going to be able to forge tens of thousands of ballots on their own. If even one person on your team blows the whistle, everyone goes to jail.

        (Yes there are some elections you could swing with a small number of votes. My unpopular opinion, as with Bush v. Gore, is that those are ties, morally speaking.)

        1. DaveK

          You are greatly underestimating the extent to which people are “mindkilled” by politics. Both sides at this point believe in entirely separately realities, neither of which correspond especially closely to the territory. One can certainly argue that one sides map is closer to the territory then the others, but it varies on different issues.

          I think you’re absolutely wrong about the ability of other people to hold genuine beliefs that seem inherently unbelievable to you.

          In another post, I used the Kavanaugh case as an example, but a common thing I used as an example was that both sides were not merely convinced of his guilt/innocence, they believed his guilt/innocence was so glaringly obvious that the people who expressed an opposite view didn’t actually hold that view, they just didn’t care.

          I saw many Republicans/Democrats express how that case was a turning point for them, where it became clear that the other side knew that Kavanaugh was guilty/innocent, but were willing to lie about what they knew to be true to advance their agenda.

          It was so extreme that even suggesting to either side that perhaps the other side actually believed what they claimed was seen as evidence as being on the other side because no reasonable person could possibly come to a different conclusion then the obvious one supported by the facts.

          1. albatross11

            Just as an aside (we don’t want to hijack a COVID thread with CW stuff), I noticed this phenomenon, too–I remained skeptical of the claims about Kavenaugh, while most of my coworkers seemed to be 100% convinced that every accusation was true. It was clearly hard for them to understand how anyone could remain skeptical of his guilt in light of the overwhelming certainty they had he was guilty.

    2. HeelBearCub

      Democratic party operations to file fraudulent votes on a mass scale via mail-in ballots

      Probably it is at the margin

      These statements are in disagreement.

      1. Doctor Mist

        Well, not precisely.

        The fraud we know about is of a scale that is highly unlikely to affect a national election. To scale that up enough to change a national election (i.e. tip it from 49/51 to 51/49, i.e. affect it at the margin) would be something we would probably all agree is “on a mass scale” — at least two orders of magnitude more than what is happening now, and probably more than that.

        The question — and I think there are good arguments in both directions — is whether universal vote-by-mail, implemented largely from scratch in a matter of a few months, would enable that level of scaling up.

        I don’t see that we have much choice but to try, but I worry.

        1. HeelBearCub

          I completely agree that implementing vote-by-mail presents challenges, and the less time you have to do it, the more likely there will be issues. There are, of course, states who do it successfully which proves it is possible.

          But you’d really like to see a good faith attempt to start preparing now, and even see states running primaries this way (as a way to work out kinks before the general). Some states will do that, but I have a feeling we won’t see many mixed-control or Republican led states do it. And that could lead to quite bad results if they are forced into it by events at the last hour.

    3. Corey

      Upthread I talk about how this sort of thing would be easy to detect after the fact. In this case it would be trivial – look at the public-record List of Who Voted, find dead people, lawsuit ensues. (In the gubernatorial election linked in that subthread, local media found 8 such people, though one died after election day and one was a husband/wife mixup)

      ETA: At least in NC, absentee ballots (whether early voting or by-mail) are trackable, in a way election-day ballots are not. So if someone were to do this, and it got discovered after the fact, those ballots could be found and un-counted.

      1. anonymousskimmer

        Unlikely to be the case in those other six instances, but still possible: What it’s like to be declared dead by the government. On the other hand, given the number of wrongly declared deaths per year, perhaps those other 6 cases are living persons.

        Rivers’ plight as a falsely-categorized deceased person is not singular: it is estimated that every year, some 12,200 very much alive U.S. citizens are declared dead by the Social Security Administration due to “keystroke errors.”

    4. Etoile

      This sort of thing would be of greatest concern in swing states/districts, where a few dozen votes can swing it one way or the other — and where the difference is too fine to prove anything. This sort of thing wouldn’t flip Texas in the presidential election (yet) but it would flip a local or House election, push a barely-holding-on opposition incumbent out, etc.

      1. Simon_Jester

        Yes, but there already exist plenty of methods by which such elections could be flipped.

        If you can flip an election by casting a few dozen fraudulent ballots, and you somehow know this in advance (which you wouldn’t, of course)… There exist viable ways to set up election fraud on that scale.

        The reason almost nobody bothers is that even though quite a few local elections turn out to be decided on a 50.1 to 49.1 split with a margin of less than a hundred votes or whatever… You can’t predict well in advance which elections will be that close. And since election fraud is a crime that can get you sent to jail even if (arguably especially if) you lose… It’s sheer insanity to commit such a petty fraud given that he odds are very high that it won’t decide the election one way or the other.

        Nobody wants to go to prison in exchange for a 4% chance of tipping the election for county dogcatcher in favor of their party’s candidate.

  58. James Miller

    Drive-by voting proposal: Write down your name and address and tape it to the inside of a car window along with your ID. While your window stays closed, an election worker will verify that you are eligible to vote. Then you move your car to a machine that gives you a ballot through your now opened window. You fill out the ballot in your car and then drive to the place where you put your ballot in a box. Zero human contact. Alternatively, have in-person voting take place over a month to minimize crowding thus making it safer than going to a grocery store.

    1. Edward Scizorhands

      This proposal isn’t necessarily wrong, but a problem with spreading out voting over multiple days is that it gives people who want to fraud themselves a win indications of how hard they need to work to steal it.

      Also, Milwaukee has tried drive-up voting, and there were problems since they were the first, but it seemed to work and if people are willing to learn from them it’s probably worth a shot.

      https://fox6now.com/2020/03/28/milwaukee-rolls-out-drive-up-voting-ahead-of-april-primary/

      1. albatross11

        A practical issue that applies most years but maybe not this year: a lot of times, polling places are put in schools. That’s workable for one-day elections, but maybe not for 2-week elections.

    2. Lambert

      Keeping polling stations open for longer is a good idea.
      And maybe double the number of them too.
      There’s a load of empty buildings and furloughed workers around.

      1. Edward Scizorhands

        Wisconsin ran out of poll-workers, because they didn’t want to show up. Given that poll-workers tend to be very old, I don’t blame them.

        We need to actively recruit young people to be poll-workers for November, and we need to start doing it right now. Throw money at them if you need to. Money machine go brrrr.

        1. albatross11

          Yes, most poll workers are retired people. Not a group that is going to want to come out and get exposed to a few hundred voters just now, and maybe half a dozen of them are coughing the whole time they’re in the polling place. I’m somewhat high risk, and I wouldn’t do that for the couple hundred bucks I think they normally get paid!

          I have no idea how to do this administratively, but getting healthy young people who don’t have anyone high-risk in their household to help out with the election would be a huge win for the upcoming election.

    3. Corey

      There’s already curbside voting for the disabled / elderly / etc, but it would be hard to scale that up – it involves a poll worker making multiple trips to your car while being you in the polling place (stating name and address, getting a ballot, going through the address-change process if necessary, etc.)

      In NC where I work, you have to sign an affidavit that says you are unable to enter the polling place due to age or physical disability, but nobody is going to challenge you about it.

    4. semioldguy

      What would the plan be for someone who doesn’t own a vehicle and/or doesn’t have a driver’s license?

  59. Andrew Clough

    One thing i worry about with low dosage variolation proposals is that the the intrisic immune system will wipe up the infection without the body needing to developed a learned immune response. I was infected with Lyme disease once but I never developed any antibodies to it because I went on antibiotics the same day I developed the bullseye rash.

    The large majority of the pathogens we’re exposed to are stopped by our skin and other barriers. The large majority of the pathogens that make it past that are stopped by intrinsic immune responses before they get a hold. It’s only in rare cases that you get sick enough that you need to learn to make antibodies to resist a disease.

    I would be somewhat less skeptical about route of infection making a difference. In smallpox it seemed that infection via the skin was less serious than infection via the the lungs, say.

    1. albatross11

      That’s true for other diseases, too. Pneumonic plague is even worse than bubonic plague, and inhalation anthrax is way, way nastier than regular on-the-skin anthrax.

  60. truckdriver20

    What’s going on in South Africa? Cases were rising exponentially and the situation looked scary. On March 27th they went into lockdown. Immediately after, the number of new cases dropped about a third and has been flat ever since. It’s been linear like this for over a week.

    South Africa seems to have the highest testing capacity in Africa at about ~1000 tests per 1M residents, compared to the US’s ~6000 and Korea’s ~9000. So this shouldn’t be an artifact of insufficient data, especially because their overall number of cases is low.

    Any bets onto what this is? Statistical fluke? Corrupt officials cooking the data? Climate and/or demographics making social distancing work especially well? Any predictions for where their curve goes next?

    1. matkoniecz

      They run out of tests and now are testing at reduced rate? Number of daily performed test would help in interpreting data.

      They switched to testing medical personnel? They switched to testing random samples of a population?

      Other testing change?

    2. DaveK

      Random Guess- Because of Apartheid, South Africa has a weird social setup where there are already barriers in place that reflect pre-apartheid social divisions.

      If the result of lockdown was strengthening these barriers, testing may only be getting a done on an unrepresentative group of people who are less likely to get the virus.

      Secondly, these people already had strong barrier type systems in place to safeguard their relative wealth from the poor people who hate them and have extremely high levels of criminal activity from various levels of organization.

      Related to that, there are places in South Africa where paramilitary private militias, of the sort favored by anarcho-capitalists, are an actual thing, who may be able to create relative “deadzones” between rich and poor areas which would more effectively prevent the spread from the latter to the former

      The poor areas are much more dense, and we’re talking here about extremely bad third world slum conditions versus relatively wealthy “western” conditions that already have active war level protections against such slums.

      The situation is a bit more complex as there are middle class and upper middle class neighborhoods that have declined in terms of economic status and relative safety, but have over the years had their own militias to force certian people out. The old racial divisions and rivalries are still very much a thing.

      If this model is true, it’s basically that the initial data was based on a more robust sampling of the country, and the more recent data which came after the lockdowns is based on effectively reinstuting apartheid like meausures and using data from the wealthy areas that are isolated from the rest of the country by miitary means.

      Again, no actual evidence for this, just a speculation/guess informed by knowing a little about RSA post-Apartheid (in the sense of by no means being an expert or even a lay expert, just having a little more famililarity then the average american.)

    3. keith2000

      I’m South African. Yes, the apparent low numbers of confirmed cases, deaths, and growth rates is puzzling.

      Probably data-snooping / wishful thinking, but there have been some studies indicating that the BCG (Bacillus Calmette-Guérin) vaccine may help in some manner. BCG is a vaccination is given at birth to all South Africans to protect against tuberculosis.

      See for example
      https://www.medrxiv.org/content/10.1101/2020.03.24.20042937v1

      There have been several other similar studies over the last few weeks.

      It seems to have the unintended benefit of protecting against some viral infections.
      Studies indicating BCG’s positive effects on some viral infections (not related to tuberculosis) have been around before covid-19 e.g.
      https://www.ncbi.nlm.nih.gov/pubmed/31055165

      Again, probably just wishful thinking, but interesting to consider

      Private militas are not really a big thing here. I have not encountered any in my 40 years in SA.

  61. Paul Zrimsek

    Sorry, Diplomat and Turkmen people 🙁

    And SSC reader Castilho describes their home country of Brazil

    While I’m in favor of plural they, this is one of those places where it can be a stumbling block, at least in its current state of novelty. I’m probably not the only reader who was momentarily astonished to learn that Brazil is the home country of the Turkmen people.

    1. Le Maistre Chat

      The other Turkic-speakers were just as astonished when a horde of male Brazilians canoed across the Pacific, landed in Siberia, and asked to become Turk men.

  62. HeelBearCub

    Starting today, LA County is going to randomly test for antibodies to Covid-19 in order to estimate what the exposure and spread has been in the general population.

  63. sclmlw

    Question: Which of the two interpretations of “flattening the curve” are we actually achieving? If it’s one where the same number of people get infected but we’re just prolonging the crisis (the one from the now-famous infographic) isn’t there a potential downside to flattening the curve?

    If we prolong a pandemic of a slowly-mutating virus, aren’t we giving it time to mutate and thereby ensure we experience subsequent waves? What if the next wave is worse than the first? Will people accept ongoing waves of social distancing, or would there be rioting in the streets? What if prolonging the crisis is actually causing additional crises down the road? It seems likely that a virus capable of spreading as fast as COVID-19 would flame out quickly and disappear if it were allowed to spread unimpeded – as painful as that might be. Such that the difference between the null response and flattening the curve is a difference between a bad pandemic of 2020 and a newly-emergent endemic disease. If our default response to this kind of pandemic is to slow down the spread, does that ensure newly-emerging pandemics will all become endemic?

    If, however, flattening the curve reduces the overall number of people who get infected – by controlling spread to the point of eliminating the virus – we would expect a lower overall number of cases and therefore fewer opportunities for the virus to mutate. If this happens, we should expect to see less mutation in populations that flatten the curve. (cf. Brazil, Turkmenistan, etc.)

    If flattening the curve means exactly what the infographics people usually refer to are implying – namely that the area under the two curves is essentially the same – it’s potentially a bad thing, creating new crises down the road. If it means fewer overall cases, it’s probably preventing new crises down the road.

    Disclaimer – I’m not suggesting we change course. Even if you think this is the wrong response we should make sure it’s as effective a response as possible.

    1. HeelBearCub

      The answer is that we don’t know which version, because it depends on future actions.

    2. albatross11

      I can think of a few reasons it makes sense to delay infections even if we end up with the same number overall:

      a. We can avoid having hospitals get overwhelmed with COVID19 pneumonia patients all at once, which is important because it means that the patients are more likely to survive. Your chances of surviving go way down when you’re on a gurney in the hallway with ten other very sick people, and one beginning-to-show-sympoms nurse is trying to keep track of you all while hoping the Tylenol she just took gets her fever down a bit.

      b. We buy time to learn more about how to treat the virus. Wait long enough, and there may be a protocol that everyone adopts that doubles the survival rate of people who end up in the hospital with the virus. Lots of people are trying lots of different things to treat the infection at different times, and hopefully some of them will work out.

      Both of those will pay off even if we end up with the same number of total infections, as the later infections will be a lot less likely to end up dead or permanently disabled.

      We also buy time to work out how to adjust our world to slow down the spread of COVID19 with measures short of total lockdown. The virus isn’t all *that* great at spreading–estimates are that each new infection causes about 2.3 new infections on average. Get that number down below 1, and the total number of infections should keep dropping.

      Places with lockdowns have probably got R way down, Unfortunately, they’re not sustainable long-term. But some less restrictive changes probably can keep R low enough that we can keep on top of it with testing and selective quarantines and maybe occasional localized lockdowns. My hope is that we can get the number of active infections down enough to get this mostly under control. But that seems to require, at a minimum, lots of continued measures to slow transmission, along with really extensive rapid testing (tests that give you an answer in a couple hours instead of a week).

      1. glorkvorn

        What sort of “less restrictive measures” are you imagining, that would keep the spread slow but be tolerable for the long haul? I can’t imagine that we can keep the current situation up for more than a couple more months at best. I’m worried that this massive effort to flatten the curve is all in vain, because we’re going to end up just letting it spread anyway.

        1. Edward Scizorhands

          Just spitballing, but something like “End most government-enforced lockdowns except 1) still ban events over 1000 people, 2) keep schools closed, 3) keep a hyperactive eye on nursing homes and other concentrations of the most vulnerable.”

          That would stop a lot of super-spreader events. And even with no government orders in place, lots of people and businesses are still vary of the virus, so would take a bunch of actions on their own.

          I don’t know the models. The modelers probably don’t know the models, and not because they are stupid, but because it’s an incredibly hard problem. They probably won’t know for sure until they get a chance to compare the data from different countries and regions that did various mitigation efforts, and then further watched in more controlled fashions as regions and countries try unlocking things and observe what we can get away with.

        2. albatross11

          It depends on how the virus spreads most of the time–something that’s not entirely clear. What I’ve read so far suggests that:

          a. There are known cases where people have spread the virus before developing symptoms. The claim I read said that when there’s asymptomatic spread, it’s typically 2-3 days before symptoms start. My guess is, there’s almost always a period when you could transmit the disease but don’t yet have symptoms, but you’re probably not all *that* contagious.

          b. There are many cases where people never got all that sick–they felt like they had a pretty bad cold, but didn’t want to miss work/school/their cousin’s wedding/their grandma’s funeral.

          c. There are cases where we know airborne transmission has taken place in a community setting–that choir meeting where everyone did social distancing and avoided close contact and used hand sanitizer, and a bunch of people got sick anyway is an example. At a guess, singing out like you do in a choir is probably producing a lot of droplets that have a lot of energy coming out of your throat and travel far. (Coughing and yelling probably work about the same way.)

          d. We know there is airborne transmission in hospitals, and also that hospitals have become huge sources of additional infections in a lot of places. I would bet a lot of money that right now in most of the US, nearly all new infections are coming from hospitals to staff/EMTs/other patients, and then from them back out into the community.

          e. The cases people have been able to track down don’t seem to show a *lot* of airborne transmission, and the R_0 of COVID-19 doesn’t look like it probably would if every sick person was leaving a cloud of infection behind them for a couple hours.

          The reason I care about airborne transmission is that it’s the hardest thing to stop. For most workplaces, I think it’s relatively easy to keep people 2m apart, make them wear masks (once we get the mask situation untangled), get them to wash or sanitize their hands many times a day, and disinfect all the high-touch surfaces. At that point, you’ve eliminated most opportunities for close contact and contaminated surfaces (“fomites”) like doorknobs and elevator buttons. But if everyone who breathes, eats, coughs, yells, or sings is putting very small virus-laden droplets into the air that can travel across the room and infect someone 10m away, that looks very hard to prevent.

          The reason I care about pre-symptomatic spread is because it’s pretty easy to tell people to go home if they come into work visibly sick. A fever check with a forehead thermometer at the start of the day and sending anyone who’s coughing/sneezing home catches most of the symptomatic infected people. Until we have cheap rapid virus tests, that’s probably the best we can do, but it doesn’t do anything to prevent spread by people who don’t have any symptoms.

          If airborne spread is either very rare from asymptomatic people, or blocked by making everyone wear a mask, then I think it’s not so hard to reopen most workplaces. Everyone gets a fever check in the morning, anyone showing symptoms has to go home or maybe go into a separate building/room to finish out the day, everyone stays 2 meters apart, everyone wears a mask, surfaces get disinfected regularly, we space out lunches and such to avoid close contact, etc. Similarly, you can imagine reopening restaurants for in-house dining, just spacing the customers pretty far apart and sanitizing surfaces and making the servers and kitchen staff wear masks.

          If airborne spread from asymptomatic people is relatively common, then that stuff doesn’t work so well. In that case, it’s hard to keep stores open and allow restaurants to open back up their dining rooms without having rapid spread. It’s also hard to go back to work in an office or warehouse or factory, because just spacing people out isn’t enough–you need to redesign the ventilation system or make everyone wear respirators or something.

          1. Edward Scizorhands

            Based on the choir event, and the fact that Japan kept the spread low by people wearing masks on subways, maybe airborne transmission is more important than shared-surface transmission.

            I vaguely recall that the Biogen cluster or the early Korean church super-spreader was considered to be by common serving utensils at a buffet. If that’s true, it would mean my model is wrong. But was it really the common utensils at fault, or was that just an idea while we were more concerned about hand-washing and shared surfaces?

      2. sclmlw

        I’m not disputing the potential benefits of reducing the spread; I’m familiar with all the arguments you outlined. I think we’ve discussed those upsides a lot recently, and you’re probably right that they should remain part of the discussion as we talk about pros/cons.

        Meanwhile, I’m asking whether there’s a con we haven’t considered yet: what if the end result of flattening the curve is everything you predicted, plus there’s an extra wave? Presumably we’ll be more prepared for the second wave, but it might be worse to go through this 2+ times than to go through a particularly horrible single event.

        1. HeelBearCub

          It entirely depends on what the results of an uninterrupted first wave would have been. We have a sense of what that would be based on Wuhan, Lombardy and NYC. The UK started down this path and seem to be paying a heavy price. We may be about to get very familiar if Sweden is on the course they are reported to be on.

          So, assuming that an uninterrupted course really does result in 2 million deaths in the US … well, you won’t get an uninterrupted course. Lots of people, corporations, etc. will be be making the choice to voluntarily attempt to isolate.

          And that could end up in the worst outcome, because you get much of the economic damage without the the benefits of a coordinated response.

          1. albatross11

            Right, that’s the point of the graph I linked to elsewhere in the thread–restaurant reservations were falling off like a rock everywhere as news of the virus spread, not just in places with lockdowns.

      3. nkurz

        @albatross11:
        > I can think of a few reasons it makes sense to delay infections even if we end up with the same number overall

        Another possible reason is that by waiting, you might be infected with a less harmful strain of the virus. Approximately, the argument for this is:

        1) There appear to be multiple strains of the virus.
        2) Severity of symptoms (and mortality) depends on strain.
        3) Strains with lots of asymptotic carriers are more likely to spread.
        4) Over time, the milder strains may outcompete the severe strains.

        I don’t know how likely this scenario is, but given expected human behavior I think it’s at least plausible. Consider two strains, one of which causes 20% severe bedridden cases and 80% asymptomatic; and the other 80% severe and only 20% asymptomatic. While there is probably an early window in both strains where the unknowing asymptomatic carrier is out spreading the virus, in the severe strain the carrier falls ill and is bedridden with limited outside contact. The asymptomatic carriers of the mild strain continue their normal daily routine, infecting others for a longer period of time.

        If we assume that a large amount of spreading is done by a small number of super-spreaders, this effect magnifies. An even minimally aware person isn’t going to drag themselves out of bed to attend their weekly choir practice, but a feverless individual who things they are healthy individual might choose to attend. In the right circumstances, this seems like it might lead to more people being infected with the mild strain, until herd immunity is reached and the severe strain becomes much rarer. There are lots of assumptions necessary for this to happen, but it seems worth modeling.

        1. sclmlw

          4) Over time, the milder strains may outcompete the severe strains.

          This is not a timescale we’d want to rely on. Mutations aren’t directed, they’re stochastic. So the mechanism that selects for milder strains over time is the aggressive nature of the more severe strains limiting their spread and/or persistence within the population. In other words, it could easily get worse before it gets better.

          1. albatross11

            One thing that could cause milder strains to outcompete severe ones is if everyone who shows any symptoms is quarantined and doesn’t give the virus to anyone new, whereas asymptomatic people can still pass the virus around.

          2. sclmlw

            Sure, but that could easily be an extended incubation period, or increased viral shedding in asymptomatic people; there are lots of potential mutations that could increase the spread but not impact lethality.

    3. DarkTigger

      Those two interpretations don’t need to be mutual exclusiv. We can hope that we are able to flatten the curve to a point were R<1 which means the number of new infections might fall so far, that we can return to no lockdown and contact tracing all new cases.
      We can still prepare for the case, were we do not have that much luck, and the area under both curves are the same. It still gives us more time to find a vaccine or a cure, while our public health sector is still in a shape to administer it.

    4. anonymousskimmer

      If we prolong a pandemic of a slowly-mutating virus, aren’t we giving it time to mutate and thereby ensure we experience subsequent waves?

      Not my expertise, but a virus doesn’t need “time” to mutate, it needs generations to mutate. If it infects the same number of people, and reproduces inside those people the same number of generations, it will have statistically the same number of mutation events.

      So theoretically the choice is between rapid exposure to a variety of coronaviruses (each of which can make you sick, unless you’re lucky in antibodies), or waves of exposure to a variety of coronaviruses (each of which can make you sick, though less frequently).

      If you’ve got a variety of strains circulating at the same time you have the opportunity for recombination between strains (in individuals infected with both), which may actually accelerate population diversity (e.g. flu H1N1 and H3N2 recombining into H1N2 and H3N1).

      1. Rick Jones

        Where does anybody get the idea that the virus has mutated? According to Vince Rucinello at twiv, the virus has changed 15 bases since it was first sequenced some months ago.15 of 30,000. That’s 26 bases changed in a YEAR. And most, if not all, of those changes are silent. If you are talking out you rear about strains, please cite some actual references showing sequencing. The virologists I listen to claim that one of the characteristics of SARS2 is it’s stability. Which shows how little selective pressure it is under right now.

        1. anonymousskimmer

          Darn it Rick. See the post I am responding to.

          That’s 26 bases changed in a YEAR.

          And also, read my post. Viruses do not have a mutation rate per YEAR, they have a mutation rate per GENERATION. While viruses aren’t my expertise, I know enough about polymerases to know about mutation rates.

          And yes, coronaviruses are one of the kinds of viruses that can swap domains between strains. https://www.sciencedirect.com/science/article/pii/S0966842X16000718

          SARS-CoV-2 is under as much selective pressure now from human immune systems as it ever will be (short of drug therapy, which add new molecules to select against, or which theoretically could increase the mutation rate of the virus by increasing the error rate of the RNA polymerase that replicates the virus).
          Don’t mistake mutation rates with selective fitness. Every new antibody generated by a human immune system is another attacker selecting against the virus. But this doesn’t change the fundamental mutation rate of the virus, it merely means that any mutant virus which survives the antibody binding and immune system attack will be selected for.

          1. Rick Jones

            I’m learning my virology on the fly so be patient. I’m basing the 26 base per year change on listening to The week in virology podcast by Vincent Rancaniello and others. It was Vince who used the 26 number but I take your point that it’s a bogus unit and talking in terms of replications is better. So if we’ve had 15 base changes since the first sequencing, what should be the correct denominator? Megareplications? But there seems to be a pretty strong narrative that the virus is pretty stable.
            https://www.the-scientist.com/news-opinion/relatively-stable-sars-cov-2-genome-is-good-news-for-a-vaccine-67319
            Also, if sars2 is an unsegmented virus, doesn’t that make changes less likely to either happen, or if they do, to be less virulent?
            I have to admit that I find what I read about adaptability of virus in vivo to be confusing. Richard Epstein was ridiculed for suggesting US deaths would be less than 5k, which he based on the idea that the virus would slowly become less deadly as it spread through humans. The disastrous New Yorker interview he gave even included real time refutation by a scientist. But I’ve also read that’s something like this process does occur. Probably not in the short time we are talking about here tho.
            Finally, I have a hard time tracking comments in these long comment strings. Any tips would be appreciated.

          2. anonymousskimmer

            Now you’re asking questions I can’t answer. 🙂

            Thanks for the link. I’m learning things as well.

          3. albatross11

            One datapoint here: This preprint claims a different strain circulating in Singapore with a chunk of the viral genome deleted. This makes an argument that different strains may be arising, and it’s even possible that the less virulent strain was the one that hit Singapore first, and that accounts for some of their success in avoiding many deaths. But that’s very speculative.

            As I understand it, the argument that we’re probably not seeing very different strains arising is that coronaviruses tend to be pretty stable, and that COVID-19 seems not to have changed much over six months of circulation. That suggests that the virus is unlikely to split out into radically different strains that have very different properties.

          4. albatross11

            I think the idea here is that if most of the possible mutations for COVID-19 make it less fit, then those mutated strains will tend to die off, while the strains that stayed about the same will continue successfully spreading.

          5. Douglas Knight

            No, this virus is special. It has a very low mutation rate, but most other RNA viruses have very high rates. I don’t know about coronaviruses in general, but SARS-1 had typical RNA speed.

          6. nkurz

            @albatross11:
            > the argument … that COVID-19 seems not to have changed much over six months of circulation

            I haven’t read the underlying paper (https://www.pnas.org/content/early/2020/04/07/2004999117) but this quote from a recent press release (https://www.cam.ac.uk/research/news/covid-19-genetic-network-analysis-provides-snapshot-of-pandemic-origins) seems to say the opposite: “There are too many rapid mutations to neatly trace a COVID-19 family tree.” “The viral network we have detailed is a snapshot of the early stages of an epidemic, before the evolutionary paths of COVID-19 become obscured by vast numbers of mutations.”

            Is this just different standards for “too many/vast numbers” versus “not changed much”, or are these two in contradiction?

          7. matkoniecz

            Maybe COVID-19 mutates too fast to trace family tree, vastly slower than other similar viruses and mutations are not affecting important parts so “not changed much” is still true?

        2. fallenscien

          @Rick: Check nextstrain’s tracker here: https://nextstrain.org/ncov/global?m=div

          Remember that this is an underestimate of the genetic diversity of SARS-CoV-2 in the wild, because most countries are massively undertesting and not sequencing samples from people who are infected but asymptomatic (likely giving us a narrower slice than random sampling). We’re in the millions for total cases, and in the thousands for sequences.

          We’re also always running behind. Incubation time is a delay, as is time to sample and sequence. All our results represent the state of things as they were a couple weeks ago. Cases are still growing exponentially.

          The virus is pretty stable, but the number of infections is huge. There’s a big pool out there.

          Viruses are very information-dense, with massive selective pressure to have highly-efficient genomes. Very small changes can cause major ripple effects – a single nucleotide change can cause a conformational shift in a protein which dramatically alters its effectiveness at binding host receptors, or cause changes in glycation so the virus looks totally different to the immune system. 15 base pair changes out of 30,000 is a lot.

          1. Rick Jones

            I think the nextstrain site was where Dr. Rancaniello got the idea of the 15 base change. Also they say that sars2 has a proof reading enzyme to correct for errors. But the last episode of the podcast they mention the Singapore data with a 34 base deletion.
            https://www.microbe.tv/twiv/twiv-600/
            I’ll write them an email asking about this. Let’s see if they answer on air which they do from time to time. I’ve got a lot to learn for sure. Also thanks for all the helpful and respectful comments. A refreshing change from other sites.

        1. anonymousskimmer

          True. I don’t see how that changes things much, though. At least in the short to medium term.

          1. Purplehermann

            It could change the calculus for how fast we would want to get herd immunity naturally.

            If going slow can’t do it then flattening the curve in the “everyone will get it sense” besides being harder would also allow for more virus generations

          2. anonymousskimmer

            Or you get people catching multiple strains at once.

            About the only effective way to utilize this would be to synthesize the virus in a high-fidelity manner (eliminating most chances for mutation), and infect everyone with this unmutated strain at once. Though it’s possibly also effective to have designated super-spreaders spread it to everyone simultaneously (thus minimizing the potential for mutations to build upon prior mutations).

            We may as well “flatten the curve” and wait for a poly-antigen vaccine.

      2. sclmlw

        Yeah, but there’s a difference between serial and parallel approaches here.

        To take an extreme example, think of a virus’ mutation if one person spread it to a billion people at a time. It has a few billion chances to mutate, but only about seven rounds to accumulate mutations. Now compare a virus that is passed from one person to the next billions of times. There is redundancy built into the genetic code, such that most mutations will be benign. Even mutations that change an amino acid usually just change from one hydrophobic aa to another similar one, not impacting overall function. Certainly the antibodies of the person who passed the virus to you will still be able to recognize the slightly mutated version.

        However, if you continue to accumulate mutations over time – by slowing down the reproduction rate to >1, but less than what it would be without intervention – you’re ensuring the virus goes through more serial rounds of mutation events. The resulting virus, like the classic game of ‘telephone’, will carry dramatically more mutations than one with a much shorter path through the population. Such that by the time it makes it back around to you it has mutated beyond the point where your immune system is capable of recognizing it anymore.

        1. anonymousskimmer

          I recognize this. This is why I mentioned “super-spreaders” in an earlier comment.

          You are ignoring the fact that for one person to be that contagious they have to have many replication (thus potential mutation) events in their own person. One person cannot spread the virus to a billion people.

          Ultimately I still believe it’s better to minimize the number of infections until a vaccine or successful treatment is developed.

          1. sclmlw

            Right, like I said the billion-person super spreader is an extreme example used to illustrate the concept of how serial versus parallel infections impact mutation rate.

            The comment of yours I was responding to stated, in part,

            a virus doesn’t need “time” to mutate, it needs generations to mutate. If it infects the same number of people, and reproduces inside those people the same number of generations, it will have statistically the same number of mutation events.

            As I read it, that comment is claiming that it’s a simple matter of adding up the total number of infected people and asking whether it’s the same in one scenario as in another. I think that’s a justified interpretation of the comment, since this was in response to my initial query about whether slowing down the rate of infection (bending the curve) could be causing additional waves of virus if the reproduction rate remains above 1.0. Regardless of super spreaders, if you lower the reproduction rate, but not below 1, such that the virus remains in circulation longer you’re increasing the probability of creating additional waves. This is because the path matters in accumulating mutations, which your earlier comment assumed was unimportant.

            (Obviously, if our efforts successfully reduce the replication rate get it below 1, then fewer people overall will be infected and the calculation gets a bit more complicated.)

            Whether the current approach to limiting the spread of disease is the best solution is speculative. If we go through another round of SARS-CoV-2, where a similar number of people die to the first wave, and our current vaccine is no longer any good, it’s possible that more people die than if we acted differently and experienced only one wave. Of course, you can never know whether the counterfactual would have prevented the second wave, so in part the question of which approach would be best will likely remain unknown.

            My intention is just to introduce this idea into the conversation as it isn’t something I see generally discussed. Each potential solution has both positive and negative consequences. That doesn’t invalidate the current course of actions, but it would be irrational of us to dismiss a concern because we don’t like the way it complicates matters. It’s possible to both admit that the current course is likely increasing the probability of a second wave and support the current global approach as the best strategy available given the current state of the evidence.

    5. DaveK

      You failed to mention one of the most common justifications for “flattening the curve” and the one that seems to have the most validity, in that I haven’t really seen any counter-argument against it.

      If the virus spread unchecked, hospitals will be overwhelmed, and thus many more people would die not from the virus itself, but from the lack of medical care for everything else.

  64. Jaskologist

    Varad Mehta has a pretty balanced piece on what went down with the Wisconsin election.

    tldr; Democrats had scheduled the elections in order to give themselves and edge in the court elections. Gov Evers refused to delay the election because he doesn’t have the legal authority. He finally asked the Republican legislature to move the election (possibly after polling indicated the Democratic judge was going to lose), and they gave him the finger, so he declared it moved without them.

    Courts ultimately agreed with Evers’ earlier statement that he doesn’t have the authority to move elections unilaterally.

    The details of mail-in ballots were probably of secondary concern.

    1. fallenscien

      It bothers me that Mehta states, “Evers’s dithering and fecklessness is the primary cause of the imbroglio” when Evers never had the legal authority to delay the election.

      Delaying the election would have required Evers and the Legislature to both agree to a new plan. Evers flopped all over, but the Legislature stuck to their guns in making the election move forward as normal.

      Evers was assuredly dithering and feckless. But how is he the primary cause of an outcome he had no ability to change?

      I’d think differently if the Legislature had passed a bill and he’d vetoed it. But that’s not what happened.

  65. dark orchid

    It would be premature to say we’re now winning the war on coronavirus. But we’ve stopped actively losing ground. If we were going to win, our first sign would be something like this.

    Sounds like a pretty good parapharase of: “This is not the end. This is not even the beginning of the end. But it is, perhaps, the end of the beginning.”

  66. RC-cola-and-a-moon-pie

    I hate to post two separate questions under the same post, but I can’t resist posing one more. Has anyone seen any further analysis of the zinc question? My takeaway from last time I saw this issue discussed here was (1) there were decent theoretical (or analogical from other related conditions) reasons to think that early consumption of the right kind of zinc lazenges may reduce the severity or duration of the illness caused by this virus, but (2) there was no direct evidence of an effect on this particular virus and in any event any effects were unlikely to be large, and (3) there were some worrying risks, including even frightening neurological-related effects that might come with ingesting these things. My tentative bottom line was that if I contracted covid-consistent symptoms that I would suck a lazenge or two given the seriousness of this virus, but not without some trepidation. Have there been any sort of developments in this area? Is my takeaway at least reasonable?

    1. keaswaran

      My takeaway of the discussion was that I should take a zinc lozenge if I think there was a possibility I was infected in the past couple hours, but that if I wait until symptoms develop, then it’s too late for the zinc to do much.

      However, the discussion of the importance of viral load is making me think there might be something relevant. If we think of the body as a city and the cells as people in the city, then the idea is that the height of the peak of the epidemic is determined by how many infected people there were at the point that protective measures started being put into place (which appears to be what we are seeing with the differences between European countries and between American states).

      The zinc would then function as something that prevents spread to the cells that it directly coats. In the early phase of the infection, this might help the body’s response overwhelm the outbreak, but even in somewhat later phases it might do something. But the analogy suggests that it would still only be relevant in the ramp-up, when the number of infected cells is increasing quickly. Which still suggests that once you’ve developed symptoms might be too late, if a lot of people don’t notice symptoms until a few days into the infection.

      1. albatross11

        I’m pretty sure a lot of hospitals are currently trying zinc with their COVID-19 patients, but it’s possible it either doesn’t help much or doesn’t help much at that stage in the infection.

      2. Rick Jones

        My understanding is that Zn interferes with rna transcriptase but this only takes place inside the cell so having lots of Zn around In the plasma doesn’t help unless there is a way to transport it into the cell. One report suggested that might be how plaquinil works, if it does. And there’s also the possibility that the is a Zn transport system we don’t know of.
        But if it’s this simple then why doesn’t it work with other retrovirus like HIV?

        1. anonymousskimmer

          If HIV has already integrated into the host genome it doesn’t need functional reverse transcriptase anymore.

          So if your understanding is true, its plausible that sufficient intracellular zinc would prevent HIV from incorporating at all. But why would anyone take this amount of zinc in the forms allowing it to be present intracellularly before already being infected with HIV?

          Coronaviruses aren’t retroviruses, so the mode of action of zinc would have to be something else.

          Edit to add: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2973827/
          Zn2+ Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture

          1. Rick Jones

            Good points. And thanks for correcting my misconception of sars2 as a retrovirus.
            But you still need a transport mechanism for zn to enter the cell which I guess the pyrithione effects?

    2. Lambert

      Speaking of things that might stop it in the early stages of infection, has anyone studied the effect of trypsin on coronavirus?

      Coldzyme AB make a trypsin-based throat spray that’s been found to be effective at stopping colds, if you use it as soon as symptoms are beginning. Trypsin is a protease that damages the viral proteins so they can’t infect cells.
      But the studies tend to be about the effect on things like rhinovirus and influenza.

      1. fallenscien

        Seems unlikely to help.

        SARS-CoV-2 is a lipid-enveloped virus studded with glycoproteins. The proteins are so covered in glycans that there’s hardly any protein surface that’s accessible – that’s one of the reasons it’s so good at evading the immune system.

    3. DaveK

      I think mega dosing vitamins and mineral is a dubious proposition. While nutrition science is generally pretty weak, it is clear that balance is key.

      I would think the best option is to split the difference. Take zinc supplements, but not lozenges.

  67. Gilbatron

    the entire german immunity certificate thing has been blown completely out of proportion and badly translated.

    a reporter at a press conference asked about that and the answer was that such certificates were possible.

    that’s not the same as “germany to introduce immunity certificates”

  68. smilerz

    Setting up mail-in voting nationwide will not be a trivial task.

    There is essentially no chance that it will be done well, and will open itself up to scores of lawsuits and court battles and like Scott, my biggest concern will be Bush v Gore times 1000.

    1. albatross11

      Changing the rules or operation of an election on short notice is always going to be painful. You’re dealing with local and state laws, but also with what equipment and resources local election officials have, and a lot of local election officials have very little money, not much staff, and a pool of mostly old retired volunteers who are probably not showing up for the COVID-19 election when this virus is so dangerous for old and sickly people.

  69. The Nybbler

    Case numbers which include the US are still not meaningful. New York and New Jersey at least are not ramping up testing nearly fast enough to produce numbers which aren’t mostly artifact, and these states have the largest number of cases in the US. Daily positivity in NJ has been around 50%, NY was 50% but has dropped to around 40%; they’re still only testing people with severe symptoms.

    There’s no civilizational decline. If the government ever legalized building things quickly again, we’d be mopping the floor with China within weeks.

    Big laconic “if” here. That’s never going to happen; the government regulations are the mechanism of the civilizational decline. It’s good that we haven’t forgotten how to build things, but that red tape isn’t going away.

    From the risk to young people article:

    Young people exposed to COVID-19 are as likely as old people to become infected and contagious.

    The data I posted in an earlier thread from the Diamond Princess suggests otherwise, and nothing in the article supports this statement that I can see.

    1. DaveK

      “Big laconic “if” here. That’s never going to happen; the government regulations are the mechanism of the civilizational decline. It’s good that we haven’t forgotten how to build things, but that red tape isn’t going away.”

      I do think the pandemic is likely to create political pressure for significant changes.

      I’ve already heard politicians and people from both sides of the partisan divide pointing out that it might be time to rethink the cost/benefit analysis of having all our supply chains be globalized and often under the control of nations which may be hostile.

      Of course these kind of discussions could go either way. There have been a lot of people arguing that China should be a model for their effective response, and the US should be organized more along centralized lines. It’s somewhat ironic, as these people are often the ones to be most critical of the failures of the federal government, but seem to be arguing a solution is to give the federal government more power and more responsibility.

      1. The Nybbler

        I do think the pandemic is likely to create political pressure for significant changes.

        Sure, like you say, changes towards the Chinese authoritarian model. More power for public health authorities, stronger price-gouging and rationing laws, maybe government stockpiling of masks. If Trump wins in November, probably some made-in-America requirements. Lasting travel restrictions and intrusive anal physical probes at the airport (used mostly to catch drug mules of course). But we’re not going to see a loosening of FDA regulations, let alone any sort of of relaxation of the various restrictions which make building hard — the National Environmental Policy Act, the Americans with Disabilities Act, various gold-plated building codes, union requirements, etc. Those are outside the Overton window and getting further outside.

      2. Christophe Biocca

        I’ve already heard politicians and people from both sides of the partisan divide pointing out that it might be time to rethink the cost/benefit analysis of having all our supply chains be globalized and often under the control of nations which may be hostile.

        Mercantilist (exports good, imports bad) positions have been held by the majority of Americans since before independence, though. Of course people who already want to decrease imports will claim that coronavirus demonstrates the wisdom of that position. Everyone is interpreting this thing more-or-less as a confirmation of their priors.

  70. Gilbatron

    People who are immune should consider donating blood/plasma. A transfusion of antibodies can help.

    Many universities and large clinics in europe are looking for these donations right now. Pretty sure it’s the same in the US.

    Edit: this is not about regular donations. It’s about donating to a place that makes works on that specific treatment.

  71. noyann

    What ex-infected, immune helpers can do

    – Run errands for people that are high risk (at home, in nursing homes) or in hospitals with no visitors. Some communities and churches may already have organized something to join.
    – Shops may want someone for delivery services.
    – Entertain the kids for a few hours/day in large families where both parents work from home.
    – Volunteer in hospitals or nursing homes take low qualification tasks off the staff.
    – Keep company or entertain patients/seniors who don’t get visitors.

    1. SolipsisticUtilitarian

      Working in nursing homes would be extremely beneficial, as nursing homes are both full of at risk people and a perfect breeding ground for a fast spread of the virus. Therefore reducing the likelihood of a sick nurse introducing the virus should be a key concern; I can imagine a team of stand-by volunteers with a quick training in the basics of nursing temporarily replacing a team of nurses when there is a suspected case among the nurses.

      1. Don P.

        We should note that an immune person can still transmit the virus by touch, so they’re not a panacea.

  72. TheTurtleMoves

    Volunteer opportunities: here in NYC a lot of volunteers are just running errands for people, such as getting groceries for people at high risk of infection and doing no contact deliveries. Seems like that would be necessary everywhere.
    If there’s no one organizing that wherever he or she is it seems like word gets around pretty fast with as little as a Facebook post.

  73. TheTurtleMoves

    On the election: the two most likely scenarios in my mind are…
    1) The President calls for a delay, which only Republican governors abide by, yielding Bush v. Gore X 1000
    2) Hardly anyone votes because vote-by-mail is barely implemented anywhere, yielding Bush v. Gore X 1000

      1. smilerz

        That depends on how the delay came about.

        The SCOTUS decision was really narrow and amounted to “judges can’t change the rules, only legislatures can”

      2. Clutzy

        It simply means there is no US Constitutional provision or statute that guarantees a voter the right to a delay of an election. The date of the election is set by Congress already, so that can only be changed with a statute that passes both houses and gets signed in time. Governors have no power there.

        This is going to have to be a state-by-state discussion as to what provisions they want to have to make voting less infectious.

        1. anonymousskimmer

          It simply means there is no US Constitutional provision or statute that guarantees a voter the right to a delay of an election.

          I believe it’s broader. It explicitly doesn’t allow for the votes (except at in-person polling sites) of people who followed the law as written and asked for absentee ballots before the cut-off. It can be presumed that some of these late, but in-time, absentee requesters actually cannot vote in person.

          So this ruling states that the incompetence (for whatever reason) of the government to provide ballots means that portions of the people can be disenfranchised of their votes. How this passes the “republican form of government” clause, the 14th amendment’s “equal protection” clause, or in the near future the 14th’s section 2, I do not know.

          1. Clutzy

            Its not incompetence, its a policy choice. There is no constitutional right to an absentee vote (although some courts will undoubtedly conjure it at some time). The state provides that privileged at their discretion, and if a flurry of people driven mad overwhelms the system that is not incompetence, its just a systemic weakness, no different than the TP shortage.

          2. HeelBearCub

            Once the state sets the rules for an election, they aren’t supposed to be able to arbitrarily change them. Granting only some people who followed the rules, and not all, an absentee ballot is the part that is disenfranchisement.

          3. Clutzy

            Only if those people legitimately had no other avenue for exercising the franchise. You could probably bring an equal protection claim if you were a bubble boy or something like that, but in that case you would have requested an absentee ballot far earlier.

            The constitution does not mandate impossibilities.

          4. anonymousskimmer

            @Clutzy

            There’s no Constitutional right to an in-person vote, either. I believe a strict reading of the 14th amendment section 2 (“when the right to vote” [for] “the Executive and Judicial officers of a State” [is] “in any way abridged”) should reduce representation of Wisconsin by the fraction of voters who lawfully requested an absentee ballot in time yet were mailed that ballot too late to send it back to be counted.

            We have a spreading virus. How can you be certain a person didn’t become sick, or have a household member become sick, the last day to request absentee ballots, and immediately request an absentee ballot in order to vote?

            Likewise, how can you be sure that the person doesn’t work for a company that called them in to work during election day as essential personnel? Given the line lengths presumptive on election day (with the closing of so many polling stations), the three hours mandated time off to vote may be insufficient to vote.

            No, the constitution does not mandate impossibilities. Which is a reason why the Supreme Courts of Wisconsin and the US were wrong to insist upon post-by date. And why Wisconsin should have it representation in Congress reduced proportionately.

          5. Clutzy

            Again, no. The reduction clause wasn’t even used when states had poll taxes. To invoke them you need intentional and discriminatory infringement.

            C-19 is no different than gang violence or seasonal flu or traffic in its reduction in your ability to go to the polls. Traffic fatalities are probably the most apt. The chance of dying in an accident going to the polls is probably within an order of magnitude of the chances of catching and dying from C19 in a single poll visit. People are pretending that going to the polls creates nearly 100% chance of catching C19. It isn’t close to that. If you were particularly concerned you can wear gloves, trashbags, goggles, and a mask and reduce your chance of catching it to something like .1% on a trip. If you do that, your chance of dying on the drive is much higher.

          6. anonymousskimmer

            @Clutzy

            The huge decrease in the number of polling stations is not equivalent. It is action taken by the government which immediately abridged the ability to vote. The government needed to staff all polling locations, or create an alternate method of voting. It decided not to, thus it decided to abridge the ability to vote.

            I am fully aware that the text of the law doesn’t matter, what matters is how judges rule on how people should interpret the text of the law. This is unfortunate.

          7. matkoniecz

            @Clutzy

            If you were particularly concerned you can wear gloves, trashbags, goggles, and a mask and reduce your chance of catching it to something like .1% on a trip. If you do that, your chance of dying on the drive is much higher.

            0.1% chance of dying on one commute translates to 30% chance of dying over 340 commutes.

            https://duckduckgo.com/?q=0.999%5E340&t=canonical&ia=calculator

            And 97% chance of dying over 3400 commutes.

            https://duckduckgo.com/?q=0.999%5E3400&t=canonical&ia=calculator

            If 0.1% is a real chance then it is vastly higher than chance of dying in a traffic accident.

            (even after adjusting that not all infected from COVID suffer/die it is likely still higher than a traffic accident risk)

    1. Some Troll's Serious Discussion Alt

      I doubt Trump would call for a delay. Hes got a big advantage in voter enthusiasm, pulling record turnouts in primaries that are basically just there to confirm him as the incumbent while Democrats are down from 2008 despite the wild battle their primaries were.

      It being a bit dangerous and scary to go vote favors him.

    2. Edward Scizorhands

      Every state has absentee ballots. They need to change the rules so that we have absentee-voting-on-demand, and then scale up the number of ballots they print.

      (A reminder I hate absentee-ballot-on-demand. But there are lots of things I normally hate that we absolutely need to be doing right now, and this is one of them.)

      1. zzzzort

        Really we only need to change it in a few states. Most states already have no-excuse absentee ballots, and most states don’t have competitive national elections because the US electoral system is dumb. So really it’s just Pennsylvania and Virginia and maaaybe Texas and South Carolina.

    3. Tarpitz

      Leaving aside the question of what will happen, from my perspective as a Brit who has little enthusiasm for Trump or Biden but would marginally rather see Biden in the White House, what should happen if all coordination problems could magically be solved is a delay. We didn’t have a general election between 1935 and 1945. Neither Chamberlain nor Churchill (that time) won one. It didn’t do any lasting harm. No-one should be trying to change governments in the middle of a genuine externally imposed national emergency.

      1. EchoChaos

        Americans would be furious. Both the USA and the CSA held elections on schedule during the Civil War.

        Our national character is such that we do this because we are proud of our heritage.

        1. Matt M

          We also allowed bars to remain open and baseball games to be played and weddings and funerals to happen during the Civil War, too.

          We’ve already crossed lines we’ve never crossed before. What’s one more?

          1. John Schilling

            Cancelling baseball games doesn’t cause half the United States Army to believe that its sworn duty is to enforce martial law like President Trump ordered while the other half believes that its sworn duty is to put down the Trumpist mutineers like President Pelosi ordered, or vice versa.

            Seriously, everyone who thinks the elections should be postponed: If the United States of America does not hold a presidential election in 2020, A: what is the name of the person who you expect will be the President of the United States on 21 January 2021 and B: what fraction of the people who disagree with you do you imagine will put down their guns just because people like you explain to them that they are wrong?

          2. Tatterdemalion

            Seriously, everyone who thinks the elections should be postponed: If the United States of America does not hold a presidential election in 2020, A: what is the name of the person who you expect will be the President of the United States on 21 January 2021 and B: what fraction of the people who disagree with you do you imagine will put down their guns just because people like you explain to them that they are wrong?

            I don’t think it will or should happen, I think that the odds of it happening without bipartisan consent are virtually nil, and I think that if one side tried to postpone it against the wishes of the other the results would be just as catastrophic as you imply.

            But if the outbreak has gotten worse rather than better in November, it doesn’t strike me as beyond the bounds of possibility – vanishingly unlikely, sure, but not impossible – that the senior Democrats and the senior Republicans would agree to postpone it.

            And if that happens, whatever deal they strike will include an answer to that question, probably along the line of checks and balances that made it impossible for anything to happen without bipartisan consent, and I’d expect most people on both sides to accept it.

            What happens if Democrats and Republicans come up with a mutually acceptable deal to postpone the election, but the SCOTUS – not unreasonably – says that actually you can’t just ignore the constitution and lock in two-party rule, even if the alternative is an election where voting in person is dangerous and irresponsible, I don’t know.

          3. HeelBearCub

            If we somehow don’t hold a general election in November, which I would put at a very small percentage chance, just over zero, I believe the constitution and the law would make Patrick Leahy President. There would be 67 senate seats whose term had not expired, making Leahy the ranking majority member. There wouldn’t be any House members, and the US would be fairly severely hamstrung in terms of making very much of anything non-executive happen, legally speaking, owing to no sitting House.

            I don’t think it’s germane, but it’s somewhat interesting.

          4. John Schilling

            it doesn’t strike me as beyond the bounds of possibility – vanishingly unlikely, sure, but not impossible – that the senior Democrats and the senior Republicans would agree to postpone it.

            The problem is that “the senior Democrats and the senior Republicans” don’t have the legal authority to postpone it. It would take at least one constitutional amendment to do that, with three-quarters of the state legislatures signing on. Or, I suppose, a constitutional convention, but if we’re not having elections because it’s a bad idea to have lots of people coming together for a common purpose…

            I believe HBC is correct that a pedantically literal interpretation of the laws and constitution we currently have, would make Patrick Leahy president at noon on 20 Jan 21 if there is no election this year. But, good luck getting a broad coalition behind that. Good luck getting Donald Trump to agree to that.

            And if you do, remember that the lesson of both Donald Trump and Bernie Sanders is that many and possibly most Americans now believe that “the senior Democrats and the senior Republicans” no longer represent the will of the American people and should not rule over the American people. If “the senior Democrats and the senior Republicans” come to a backroom deal that makes a senior Democrat the new President in a way that looks not at all like a legal presidential election and requires a full-bore Voxplainer to walk people through why it might be legal anyway, then it’s the law that is going to break.

          5. Doctor Mist

            John Schilling, can you elaborate? What I see in the Constitution as currently amended suggests a few workarounds.

            First, per Article 2 Section 1 part 4: “The Congress may determine the Time of chusing the Electors, and the Day on which they shall give their Votes; which Day shall be the same throughout the United States.” So I don’t see why Congress could not change the date.

            Now Inauguration Day is specified per Amendment XX: “The terms of the President and Vice President shall end at noon on the 20th day of January, … and the terms of their successors shall then begin.” So changing Election Day gives you only two and a half months of grace.

            But also in Amendment XX, “Congress may by law provide for the case wherein neither a President elect nor a Vice President elect shall have qualified, declaring who shall then act as President, or the manner in which one who is to act shall be selected, and such person shall act accordingly until a President or Vice President shall have qualified.” It doesn’t say anything about why neither one qualified. So it seems like legislation could, say, postpone the election until fall of 2021, when we might plausibly have a vaccine, and could even state who would be the President Pro Tem until then. (I can’t see any prospect of such agreement, since I assume “by law” means the House and Senate would have to pass a Bill and the President would have to sign it. But, you know, if we’re coming up on November and Covid is back worse than ever, and Biden or Trump dies from it, well, who knows? If both sides thought they might have a better chance a year later, you might see bipartisan agreement even neglecting the potential for saved lives.)

            I’m a little unsettled to conclude from this that for ninety years there has been a path for the Congress and President to appoint a permanent dictator any time they wanted to. What am I misunderstanding?

          6. anonymousskimmer

            @Doctor Mist

            IMO only, and plenty of times I don’t understand how the government can get away with what I see as unconstitutional things.

            I think you’re missing that “shall have qualified” is past tense, not future tense. And that the Constitution itself is the sole arbiter of said “qualifications”. Congressional statute is not. So Congress cannot move the voting date past the 20th of January. It doesn’t have the power to eliminate this qualification in this manner.

            And two: the Congress which can choose a President is not the outgoing Congress, but the incoming Congress (which also wouldn’t exist if the election was moved).

            And three: Congress can’t do diddly about its own election (Article 1 Section 4 notwithstanding). So at most the longest they could appoint a dictator is not quite 2 years (unless sufficient numbers of the electorate were happy with the situation), or 4 years in the extreme event that they eliminate Congressional elections entirely by pushing them far into the future (and thus eliminate Congress). However given that the states are Constitutionally guaranteed Congressional representation, I don’t believe Congress can eliminate Congressional elections by pushing them into the future, and even if they could the states could just special elect or appoint new Congress people. So here’s your limit – 17 days shy of 2 years (Jan 20th to Jan 3rd) or the will of the people.

            And 4th: Presidential term limits.
            ————
            Aside: If you’ve got a popular president termed out, it may be worth running them again. Their VP pick would automatically become President.

          7. Doctor Mist

            anonymousskimmer:

            Well, the business of the dictator was a throwaway coda to my message. I’m really more interested in whether there is really anything that would prohibit a principled and bipartisan delay of the election in the current emergency.

            But since you are so kind as to engage with my absurd hypothetical:

            the Congress which can choose a President is not the outgoing Congress, but the incoming Congress

            “Shall have qualified” is definitely the future perfect tense, not the past tense. The language of the XXth is what enables the current legislation that specifies the order of succession, which is definitely an earlier Congress specifying who gets to be President at some unspecified point in the future. I don’t know anything that would prevent analogous legislation, except that instead of specifying the algorithm it names names.

            So at most the longest they could appoint a dictator is not quite 2 years

            There’s no automatic sunsetting of Congressional acts, so the appointment of a dictator wouldn’t just automatically expire when you got a new Congress. You’re right that a new Congress could end the whole thing by passing (with a veto-proof majority) legislation that actually names a new Election Day.

            The XXth does say explicitly, as noted, that a Presidential term ends on Jan 20, so I guess the hypothetical dictator would be bound by that.

            Term limits affect whether a person who served previously can be elected, which probably technically doesn’t affect whether someone could be appointed by Congress. Ooh, so bring Obama back, or Bush. That would be trippy.

            Another thing I ignored, both for my real question and for my absurd hypothetical, is that the election that matters is that of the Electoral College, on the first Monday after the second Wednesday in December. The Constitution doesn’t say anything about how Electors are chosen by the states; theoretically a state that is (desperately) worried about Covid could choose them in some way that does not require a state election, though probably some (or most?) states specify the process in their own constitutions.

          8. Doctor Mist

            To be honest, if we* conclude that Congress can change the date of the election, it might well make more sense to move it up to late July or early August rather than to delay it until next year. There seems a fair chance that the danger from Covid will be much smaller in midsummer than it will be in early November.

            * The august body of SSC, who can surely be entrusted with that decision.

          9. anonymousskimmer

            You’re correct about the tense. I meant that the indicated event took place in the future past, not in the future future. Therefore it’s possible Congress is prohibited from negating that future past event. This would be an unusual reading of the prohibition of ex post facto laws, but given the additional Constitutional weight against eliminating the election of a President, it seems a plausible interpretation.

            Moving the election up would cause the writer’s of the 20th amendment to roll in their graves, given the primary purpose of the amendment was to decrease the lame duck period. 🙂

          10. Garrett

            Could individual States change their laws locally to “chuse electors” in a different way for this election? As one hypothetical example, they could randomly select Electors from a complete Statewide list of registered voters. Then you’d only have at-most a few hundred people who need to gather for the process.

          11. Edward Scizorhands

            In theory, the Constitution says the States can do that.

            As soon as someone does that, though, you’ll get a lawsuit saying people are being disenfranchised, and you only need one Federal judge to agree to stop it up.

          12. Doctor Mist

            Then you’d only have at-most a few hundred people who need to gather for the process.

            I think Edward Scizorhands has the right substantive answer, but it’s interesting that the Electoral College doesn’t actually meet as a body. According to archives.gov:

            The electors meet in their respective States, where they cast their votes for President and Vice President on separate ballots. Your State’s electors’ votes are recorded on a Certificate of Vote, which is prepared at the meeting by the electors. Your State’s Certificate of Vote is sent to Congress, where the votes are counted

            Sort of obvious when you think about it. The Electoral College is not a deliberative body — they aren’t going to debate the question, they’re just going to vote. It’s almost more of a surprise that even the Electors for a given state assemble. I guess it means there doesn’t need to be another entity that vouches for the results of the vote, and saves the Congress from having to validate 538 individual ballots.

            Anyway, this means the largest assemblage would be California’s with 55 electors.

          13. Garrett

            > they aren’t going to debate the question, they’re just going to vote

            I wasn’t arguing that they would debate the issue, so much as that they would be required to gather. Hell, they could all be given level-A hazmat suits.

            I took the Constitutional phrase “The Electors shall meet in their respective States” as a requirement that all the Electors end up in the same place at the same time to sign/seal/deliver their ballots.

          14. Doctor Mist

            Garrett-

            Yeah, I think that’s right. One might imagine some interpretation of “gather” for modern/coronavirus times to include videoconferencing, as I gather even the Supreme Court is using to hear cases. But my main observation was that you won’t see an assemblage of 538 Electors even in normal times. Not that that matters at all for what we are discussing.

      2. Edward Scizorhands

        Our next Presidential term starts on January 20th. It’s written into the Constitution.

        We have regular elections on a schedule, not when there’s a vote of No Confidence.

      3. Lambert

        I, for one, would love to see what forcing the republicans and democrats into a Government of National Disunity would look like.

      4. Loriot

        As an American, the idea of canceling the election is simply unthinkable. No matter what happens, half the country would be (metaphorically) up in arms.

    4. DaveK

      Worth noting that even before the pandemic, people opposed to Trump expressed concern with a scenario where the vote was close (which it probably will be), there are irregularities, (which there will be) and Trump and a significant contingent of his supporter refuse to accept the results, alleging a democrat/deep state conspiracy.

      Given that I’ve heard republicans already discussing fears about a conspiracy to steal the election from TRump and how this must be resisted or it’s the end of democracy, and how a number of people on the left have thought about this as a real possibility, I don’t think such a scenario is so remotely unlikely as to not be worth considering.

      1. EchoChaos

        Trump and a significant contingent of his supporter refuse to accept the results, alleging a democrat/deep state conspiracy.

        Well, we’ve already seen what happens when the Democrats and a significant contingent of their supporters refuse to accept the election, alleging a Russian/Republican conspiracy.

        Why do you think the opposite way would have any effects any more substantial?

        1. John Schilling

          Aside from the four more years of political polarization, and the differences between Republicans and Democrats, and the differences between vote-by-mail and in-person voting, there is the difference between the Russians of 2016 and the Russians of 2020. The Russians have had four years to study what does and does not work in terms of reducing the perceived legitimacy of America’s elected leaders, and are almost certainly better at it than they were four years ago. The Chinese, North Koreans, et al, have probably been paying close attention as well.

          Unless the United States takes steps to increase the perceived security of the electoral process, it is reasonable to expect that there will be more vocal and active dissent this time around – regardless of who wins. If instead we basically admit that we are going to increase our use of less-secure electoral processes because coronavirus, that’s just going to make the legitimacy problem worse.

          1. Garrett

            > reducing the perceived legitimacy of America’s elected leaders

            From a political science perspective, all legitimacy is perceived. This is why the Divine Right of Kings needed as much support from the Church as possible. And if you couldn’t get it, you founded your own Church which taught the message you wanted taught.

            In more enlightened times we attempt to legitimize the structure on rational grounds. Sure, we don’t have a command from God, but at least we have a system that people can look at, shrug, and go “I can’t think of a way to do better across all possible metrics”. Also, we have the school system teach about how totally awesome our government structure is. Add a bit of history to add gravitas and away you go.

        2. eric23

          Why do you think the opposite way would have any effects any more substantial?

          Because Democrats (and Republicans not named Donald Trump) have historically showed a lot more concern for the law and the national good than Donald Trump has?

          1. EchoChaos

            @Scott: Accidentally reported. Nothing wrong with the comment.

            @eric23

            I am going to suggest that partisan effects may be blinding you a smidgen here.

            From my perspective the Democrats spending 3+ years on a clearly spurious investigation was worse than anything Trump has done in terms of lack of concern for either the law or the national good.

          2. eric23

            a clearly spurious investigation

            I’m going to suggest that partisan effects are blinding you, not me. I find it hard to describe an investigation that convicted Trump’s personal lawyer, campaign chairman, and several close advisors, and did not clear Trump of accusations but rather concluded that it lacked the authority to charge Trump, as “clearly spurious”.

          3. Garrett

            > historically showed a lot more concern for the law and the national good than Donald Trump has

            Counterpoint: one of the things that makes Donald Trump particularly interesting is that he seems to be a master at (mostly) following the letter of the law while spitting in the face of the spirit of the law.

            As for concern for the national good, I find it hard to develop a model which separates someone who doesn’t care for the national good but claims to care, someone who cares but only secondarily to other goods, and someone who cares for the national good but simply has the wrong policies to go about it. That is, separating malice from stupidity is very challenging, especially with someone like Trump.

  74. meh

    i am going to assume that having a segment of the population mark their clothing to be distinguishable is pretty taboo in germany

        1. Leafhopper

          “Okay, everyone, get your stars out again — this time, they confer privileged status.”

          1. Edward Scizorhands

            When the Star-Belly children went out to play ball,
            Could a Plain- Belly get in the game…? Not at all.
            You only could play if your bellies had stars
            And the Plain-Belly children had none upon thars.

    1. soreff

      Would badges work as a visible marker of immunity?
      It is kind-of special clothing, but has a long history as marking a special status, e.g. police.
      (How widespread is using badges? USA/UK – but how much broader?)

  75. tgb

    Can anyone explain the discrepancy between FiveThirtyEight’s covering of how well the experts did and the tweet Scott links to? 538 makes it look like the expert’s did great, well within the consensus region, and if anything were underconfident. Yet my reading of their initial chart also seems to suggest that all but three of the 18 experts had it outside their confidence bands, with most being completely mistaken.

    Also, how do you create a consensus confidence interval from expert opinions? My first thought is using the same methods for meta analysis of papers like Fisher’s method, but it’s clear that doing that here would have generated a ridiculously narrow band and in general, surveying 1000 experts shouldn’t make you much more certain of your consensus estimate than surveying 50. Meta-analysis methods would really be estimating the average expert opinion, and the confidence interval around that is not what we should have for the confidence interval of actual value – but I don’t know what we should use instead.

    1. Edward Scizorhands

      Predicting exactly where you are along the exponential curve is really hard when you are still in low numbers.

      Instead of asking “how many cases will we have in N days” ask “how many days before we have N cases”. Small mistakes in the second will look like massive mistakes in the first.

  76. Purplehermann

    On variolation and mainstream talking about dose:

    The main issue with this method is the PR essentially.
    Most people hear “we can infect people and have lower death rates” and they react as if it was “let’s kill people, then we’ll have less dead. It’s just numbers, and this way we get better numbers”.

    So the mainstream putting the importance of dose, and how high doses are killing healthcare personnel into the water supply will make people a lot less freaked out about variolation (coronation?) for doctors and nurses, and after a little while other people as well

    This also means Robin Hanson should design his experiment to look as safe and benign as possible while still having some useful info

      1. Purplehermann

        I don’t think this is super important honestly.

        I’m guessing young healthy people have something like a 0.01% death rate in the wild, and hopefully the lower doses in safer infection sites would take us the rest of the way to ~0%.
        Either way if the first trial is robe right no one will die.

        Right now time is more important than getting a slightly milder strain.
        If it can be found fast enough to be incorporated in the first trial, great.
        If not then maybe later on.

        [Edit: it should definitely be checked too, but one test shouldn’t wait on the other]

        1. fallenscien

          This is hugely important. The point of the milder strain isn’t as much about the lower chance of harming the person we’re putting it in. It’s about transmission from that person to other people.

          We do not have any reasonable way to guarantee that someone has completely cleared a virus. There is always the possibility – and it’s a pretty strong possibility – that they will start shedding the virus again later.

          If the virus they’re shedding is an attenuated strain, great! It probably won’t infect anyone because of low copy number, but it it does, they’ll fight it off no problem.

          If the virus they’re shedding is full strength, and will kill any elderly or immunocompromised people who catch it from them, we’ve just made them a potential spark in a powderkeg.

          1. Purplehermann

            It is pretty unimportant to trials for effect/correlation of/to dose on severity.

            If variolation ends up being used because it is useful in getting more minor cases, it will be used on either those most at risk or enough healthy people to get a chunk of herd immunity.

            When days are important you don’t wait for testing one mechanism, just in case someone finds a different piece, or in case it turns out stopping the virus spreading is impossible. You start doing what you can, if someone finds a milder strain that confers immunity as well, great. It turns out people are infectious at random times years later, variolate everybody if variolation works. If not, great.

      2. tgb

        I saw this and isn’t it saying “Vaccines are too slow to develop, so let’s do this other thing instead” but the reason vaccines are slow to develop is testing them (depending on type, some are already being tested) so the slowness is inherent to anything that needs to be tested. And the new proposal is at least as risky as vaccination and needs to be tested at least as much. So the article totally failed to justify it’s position, as far as I could tell.

        1. Purplehermann

          IAMNAD, everything in this comment is my impression.

          Vaccines are not the virus (They are based on it but important changes have been made). This means that
          1. They don’t always provide immunity
          2. They sometimes make things worse than the virus itself.
          3. The vaccine needs to be produced

          With the original virus we don’t really have the first two issues, and the third is less relevant.

          If the dosing and placement are done correctly then the upper bounds of damage done is just COVID-19 infection.

          The lower bound is immunity that getting the virus gives. (If the dose is too small to provoke an immune reaction, that’s just more testing)

          If the group selected is young and healthy this really isn’t an issue.

          The death rates for 20-39 year olds Sarah C gives are 0.1%-0.2%. I think 0.1% is about right, but let’s take 0.2%.

          In NY(C?) it looks like only a twentieth of the young dead had no underlying health conditions.
          That gives us a 0.01% death rate.
          Keeping in mind that high doses seem to be particularly lethal and the virus starting off in the lungs in some cases, it looks like young healthy people are very unlikely to die from the variolation tests.

          Tl;dr this isn’t actually very risky, and is a pretty sure bet that it works to some degree, and probably will need much less testing.
          It’s not as good as a working vaccine, but trying it is probably a good idea

          1. fallenscien

            Vaccines can just be the virus. That’s what an attenuated vaccine is – a mild version of a virus, whether produced intentionally or found in the wild. See the Sabin Oral Vaccine for an example.

            Using live virus – especially when it’s a novel virus that’s poorly-characterized – can go extremely wrong very easily.

            There are a huge number of problems with this proposal. But I should be making that argument at the people who are trying to do it.

            I’m just wondering where all the real epidemiologists are at.

          2. Purplehermann

            @fallenscien an important difference between manufactured attenuated strains and low doses is ADE. Novel issues may also result, Erich is also an important difference. Attenuated live viruses are not just the virus.

            I feel that you gave a basic explanation for a concept that, while related, wasn’t actually that pertinent (or accurate) and was also generally understood.

            Then you asserted that things could go very badly wrong very easily, while dismissing this discussion as an important place to make your argument.

            This was probably just a low effort post, not dunning-kruger/jerkitude/trolling, but it’s coming off a bit like it is to me.

            Could you explain what exactly could go horribly wrong when using the normal virus?

            Screwing up the dosing is the main thing I’d be worried about, followed by infecting a vital area (like the lungs).

          3. albatross11

            The main thing that’s likely to go wrong is that you end up making your test subjects very ill and then you have a new concentration of infection to deal with. You might even screw up and give them a worse version of the infection than they’d have had normally, though I think that’s pretty unlikely if you’re careful and don’t do something like try to infect them by having them take some deep breaths of very small aerosolized droplets full of virus or something.

          4. Purplehermann

            500 people being infected isn’t a huge deal if you know exactly who they are.

            You realize most of the group would probably be asymptomatic right?
            That’s even if super low doses aren’t better than low doses

          5. fallenscien

            @Purpleherrmann

            Yeah, it was a low-effort post.

            I’m frickin’ tired. I’m spending a lot of extra effort trying to keep people close to me from panicking, and I’m doing my best to be the primary interface between my elderly relatives and anything they need from the world, in order to minimize their risk.

            I was, and kind of still am, an infectious disease researcher. Not virology, but adjacent to it. Literally. In the wake of the 2009 swine flu pandemic, I worked a couple doors down from researchers who were working on the influenza virus, and we’d talk about the possibility of another pandemic, the challenges of vaccine design, and the possibility of creating a universal influenza vaccine (which was one of the things their lab was trying to fill in the basic research needed to produce).

            I (mostly) left academia because the pay and hours are terrible, funding has been continually shrinking and that trend showed no signs of reversing, and I have some issues with fundamental ways that incentives are structured which cause our most talented researchers to spend all their time applying for grants instead of doing research. But that’s an entirely different conversation.

            In my experience, if you argue with a rationalist and hit them with a slow trickle of information against a centrally-held belief, the prior that they’re going to update is the one that says they should listen to you and seriously consider your arguments. Coming back over and over with minor quibbles to try to undermine a single belief is what biased sources of information do.

            Instead, if you want them to reconsider a firmly-held belief, you need to hit them all at once with a figurative sledgehammer of data, meticulously constructed and rigorously cited.

            In this case, that’s a whole lot of work. Because getting a person to the right place in this specific argument requires what is more-or-less a short course in viruses and the human immune system, it’s more on par with writing a chapter in a textbook than a single research paper.

            I suspect you’re not going to be sympathetic to this, but the comments section of a blog post is absolutely the wrong place to post a book chapter worth of material.

            The thing is, I’m a low-level expert in this subject as far as credentials go. I’ve never cared about those. I’m exhausted and don’t understand how it could possibly end up being my responsibility to derail the activity that Hanson and you seem to be somehow seriously trying to move ahead on.

            I am not assuming I would succeed. I’m just saying that it would be pointless to half-ass an attempt. I don’t even know if anyone would listen to me if I tried.

            At the end of the day, I’ve got a voice in my head that sounds like Dante from Clerks: “I wasn’t even supposed to BE here today.”

            I don’t /want/ to have this argument, but for some reason, it seems like no one better-qualified in epidemiology is around. So if I have to try, I’d want to actually try as completely as I can, and aim as directly and efficiently as I can at the people doing it.

            Are you a direct path to the source of this effort?

          6. Purplehermann

            I get where you’re coming from now.
            (For the record, low effort posts just telling people they’re wrong don’t seem helpful.)

            I am not a direct path.

            If you do decide to try convincing Robert Hanson I’d like to see it.

            Imo you could have done a much better low effort post…

            A hypothetical way things could go wrong that is outside what’s already taken into account, a link to some information on the risks of experimental vaccines vs variolation explaining relevant issues with the method beyond what is already being discussed…

            This isn’t a centrally held belief in any way.

            This is a “well it looks right, and most of the people protesting it are pretty much saying vaccines are better in every way, and ignoring most of the claims made, maybe a few million lives can be saved and there is very little risk. Any objections (besides: it’s stupid, for reasons)?”

            The assumption here is (should be) that the ones with central beliefs here are those saying we shouldn’t infect people, and the experts are already doing everything that makes sense.

            So while actual info should be looked into and appreciated, low effort “you’re wrong/evil/stupid/arrogant claims would be ignored, and the people making them paid less attention to on this subject.

            [Added: as far your suspicions, that was just obnoxious. An actual text book chapter is not expected by almost literally anyone.
            Also, I really am not sympathetic to a claim of “it’s so much work, and a very simplified reason it wouldn’t work is impossible, so I resorted to a fly-by ‘you’re wrong’ and explaining a concept already discussed in an unhelpful way, because this isn’t my problem.”]

      3. truckdriver20

        This is just fast-tracking a vaccine. If they do end up doing a “herd immunity” approach (which should be last resort) they should be variolating people as Hanson describes while also essentially enrolling them in massive vaccine trials. My understanding is that the reason a vaccine will take so long is because they typically need to prove that it’s safe enough to not accidentally cause terrible effects in 1/10000 people. But if we’re resigned to the fact that everyone is going to end up getting the virus without it, surely a much lower threshold for safety is acceptable (for healthy young volunteers giving informed consent, of course).

        1. albatross11

          Right. If you want to intentionally expose people to the virus in a world where we already have some experimental vaccines ready to test out, then the right way to do it is to give a bunch of young, healthy people the vaccine, wait 3 weeks, check their antibody levels, and if all looks right, challenge them with the virus and see if they {show any symptoms, have detectable virus levels on any day} over the next 14 days or so.

          Then, you not only get a pool of immune people (for however long immunity lasts–something else we don’t really know), you also now know whether your experimental vaccines provide protection against getting infected. That probably massively speeds up getting a vaccine out into use. At least the mRNA vaccine is apparently pretty easy to make in large quantities, too.

          1. Lambert

            And you can get a bunch of different candidate vaccines in the hope that at least one is sucessful.

        2. tgb

          But in what way is it fast-tracked? I don’t see any reason to expect it to be faster than vaccine development (given that some are already in the testing phase).

          1. albatross11

            You get information about whether the vaccine prevents infection much more quickly when you intentionally expose your test subjects to the infection. Note that this includes exposing the control group, who probably got a saline injection, and so who will probably all get sick. Without that, you don’t find out for sure whether the vaccine does better than just being young and healthy enough to get into the vaccine trial.

            The alternative is to wait a year or so and see what fraction of the treatment and control groups got symptomatic infections.

    1. John Schilling

      The main issue with this method [variolation] is the PR essentially.

      The main issue with variolation is the stupidity. Variolation is literally the stupidest way to try and develop a vaccine. Variolation is “let’s grab what we think is mildly-infected material from a natural source whose true potency is unknown, and see if there’s a dose that produces immunity without serious infection”. Every other technique for developing vaccines involves at least trying to apply cleverness to modify the virus for a higher immune-response-to-actual-infection ratio, culturing or manufacturing the result so that you know what you are getting, and then seeing if there’s a dose that produces immunity without serious infection.

      Every other technique for producing vaccines is better than variolation. And we’ve got close to a hundred vaccine candidates coming out of those better techniques, four of them already in human testing.

      The great advantage of variolation is that, being stupid, it can be applied by stupid people. Or, more precisely, smart but ignorant people who don’t know how to do any better, like eighteenth-century doctors. Or maybe mid-twenty-first century doctors after the apocalypse puts us all back in Mad Max land and we’ve still got plagues that need dealing with. But if you’ve got actual professional virologists and epidemiologists and proper research facilities, you don’t need and don’t want to play with variolation.

      And if you play with variolation anyhow, because you imagine yourself to be the great biohacker who is going to vanquish the plague where the professionals have failed but you don’t have the knowledge or resources to do anything better, so what? You aren’t going to be allowed to roll it out for general use without going through the same testing as the professionals, and the professionals now have a head start on that. If those testing requirements are relaxed for anyone, they’ll be relaxed for the professionals first and they’ll still beat you to the finish.

      1. nkurz

        @John Schilling:

        I think you are being too harsh. Or perhaps, your attack on classic variolation might be completely justified, but classic variolation is not exactly what Tillett is proposing.

        > The great advantage of variolation is that, being stupid, it can be applied by stupid people.

        Tillett might be wrong, but he’s not stupid. He also has a new article up describing what his approach might look like in practice: https://www.tillett.info/2020/04/12/how-would-a-search-for-a-natural-attenuated-sars-cov-2-strain-work-in-practice/.

        As I see it, the advantage of his approach is that by starting with a wild but mild strain, you have the advantage of being able to do observational outcome testing that might be impossible (or at least unethical) to obtain for a novel vaccine: Large X people were infected with this strain, small x people died. If the numbers are good compared to the base case of natural infection, helping this strain to spread might be a societal win.

        And unlike in the past, with modern sequencing it’s possible to distinguish strains beyond just looking at outcomes. Rather than just simply for strains associated with mild symptoms, Tillett also puts a lot of emphasis on checking the sequences for genetic deletions that 1) are likely to cause a change in lethality, 2) are unlikely to affect immunity, and 3) are unlikely to mutate back to a lethal form.

        > and see if there’s a dose that produces immunity without serious infection

        I haven’t seen Tillett place any emphasis on dosage. To the contrary, he deemphasizes it on the theory that what matters most is not the effect on the person that you intentionally inoculate, but on the people that are infected downstream from that person. Since you have no (or very little) control over that downstream dosage, you don’t want to be dependent on dosage. It’s probably worth re-emphasizing that Tillett’s approach is trying to make use of the natural spread of the mild strain, with the goal of outcompeting more dangerous strains through person-to-person transmission.

        > Every other technique for producing vaccines is better than variolation.

        I think this is a stronger argument. The counter-argument is that if a mild natural strain exists, and if a large number of test subjects have already been exposed to it with positive results, why wouldn’t we make use of it? We shouldn’t stop working on modern vaccines, but if it’s relatively low effort, we probably should (in parallel, using non-competitive resources) search to see whether such a strain already exists. Unless there’s a solid reason to believe that no such strain can possibly exist?

        > because you imagine yourself to be the great biohacker who is going to vanquish the plague where the professionals have failed

        I’d rather evaluate the ideas on their own merit, but Tillett looks like a fairly well-credentialed professional in the field: https://www.tillett.info/about/. You might be right that his suggestions lead nowhere, but I think it’s worth looking closely at the specifics of what he suggests, rather than quickly rejecting it based on historically similar precedents.

        1. Purplehermann

          Hanson is talking about dose specifically.

          I see little reason not to try both.

          People with the virus are hopefully being isolated, you should be able to constrain their movements. It’s only people who aren’t confirmed to have it who are an issue

      2. Purplehermann

        1. When you say “you know what you are getting”, what do you mean? Supposedly the virus has been pretty stable, with variolation you should know what you are getting, more than a manufactured or altered vaccine.

        2. Assuming the dose can be measured very accurately and the doses given are lower than normal wild infections, what do think the risk is?

        Assume healthy young people who probably would have gotten it anyway.
        Please be specific, with numbers if possible.

        3. Do you think variolation is as bad as or worse than just letting natural herd immunity occur while isolating high risk groups? (There seem to be plenty of advocates for this, there’s a chance that this will be policy). Why?

        4. Do you think variolation is less likely to give immunity than vaccines in the next year? Do you think vaccines are a sure bet i the near future?

        5. Stupidity of solutions is indeed an advantage. They are less likely to go wrong and more limely to work, even if they often give subpar results 😉
        Here subpar results may be enough considering how relatively little the virus does to young healthy people

        1. John Schilling

          Stupidity of solutions is indeed an advantage. They are less likely to go wrong and more likely to work, even if they often give subpar results

          I’m pretty sure this is false. The stupidity of variolation is that you are more likely to accidentally give people full-fledged COVID-19, of the sort that kills people. Smallpox variolation killed 1-2% of the people it was tried on, far more than proper vaccination. And it won’t be just the people who volunteer for your experiment, but also the health care workers who wind up treating the ones who wind up in an ICU, and the family members of those health care workers, etc. And those aren’t all going to be healthy twenty-somethings. But I’d love to see you defend your claim that injecting people with a natural strain of COVID-19 is less likely to go lethally wrong then injecting them with a deliberately-attenuated virus or a dead virus or a protein stripped from the virus.

          As for the rest, no, I’m not claiming that it is better than trying for herd immunity. Using the stupidest possible vaccine is somewhat less stupid than doing nothing at all. Whee.

          But, with a hundred or so smarter vaccines in the works, I think the odds are very good that one of them will work. And if none of them work, it will almost certainly be because there’s something about SARS CoV-2 that makes it highly resistant to vaccination in general, in which case variolation isn’t going to work either.

          1. Purplehermann

            I’ll try to defend it alright.

            Let’s assume the variolation is no better than a regular, wild low dose. It’s main benefit is being a constant low dose that can be administered at a determined time in a body area of choice.

            Young healthy people barely ever die from this. Most of them are actually asymptomatic. Their systems usually handle it pretty damn well.
            There are some plausible mechanisms that cause the few deaths, which can easily be avoided in a lab.
            1. Unusually high doses.
            2. The infection starting off in the lungs (or other vital area with a bunch of ACE2 receptors I guess).
            3. Worn down health before infection (lack of sleep, being overworked for example)

            With 500 people the chances of death are really low. No one should die low.

            I also think bringing the nurses who would be infected into this odd. About 2-4% young adults need ICU, and this includes unhealthy people. Unhealthy people were dying at ~20X the rate as healthy for this age bracket, if that holds for ICU admissions then we should expect 0 or 1 people in need of an ICU.
            There is no reason a single person should infect the nurses either (or at least raise the chances of an infection all that much).
            Thinking a single ICU patient (who recovers) will make a serious difference when a pandemic is going on is silly imo.

            The comparative dangers of vaccines: Immune enhancement.
            Which is why they need more testing.

            As to your last point, if natural infections give immunity but vaccinations don’t, variolation could very plausibly end up in the natural infection camp – it is a natural infection, just controlled.

            That was all assuming variolation doesn’t give any benefits beyond the givens (that you decide on health and age, make sure they are rested when it comes, able to isolate, decide where it goes and the dose).

            If it makes the disease much milder too, that would be wonderful, and it seems likely.

            Finally, we should really be trying most anything that isn’t very risky if it lessons the chances of a natural herd immunity policy imo, and I think you should agree.
            Countries are very uncomfortable waiting half a year to start their economies up again.

          2. John Schilling

            OK, first, you seem to be assuming reliable control over dosage. The only way you can get this is by isolating the virus in the lab before you dose someone with it. If you’re doing that why aren’t you (as Lambert and albatross11 note) using one of the reasonably quick and reliable techniques for inactivating the virus at the same time?

            Second, yes, if you test it on 500 healthy young people in controlled conditions, it’s highly unlikely that you’ll kill anyone. But what good is the result? All you can establish with any confidence is that variolation has a fatality rate no greater than 0.2% in the lab. If you then use the technique on the general public, you may wind up killing a hundred thousand people. Or more, because even if you only give it to healthy young members of the public for some sort of augmented herd immunity, you won’t have nearly as much control and will be e.g. variolating people who only superficially appeared healthy under a much less thorough examination than your initial test subjects.

            And when some of your people wind up in an ICU, they’ll be treated by doctors and nurses who aren’t all carefully-selected young men in perfect health. Some of them will be older men and women, some of them will be parents who go home to their families with whatever you just gave them, and pretty much all of them will be overworked and not getting enough sleep.

            Nobody is going to allow you to do any of that, especially not when you deliberately skipped the “here we inactivate the virus” step. The only way variolation can be used outside the laboratory, is if it goes through the same testing that e.g. inactivated whole-virus vaccines go through. Which we are already doing. Since inactivated viruses are rather definitively safer than live viruses, your proposed technique is more dangerous than what we are already doing. And, since we’re already doing it but aren’t doing variolation, it’s going to be ready faster. What benefit does variolation offer to offset these disadvantages?

            Again, the alternatives aren’t “variolation or nothing!” or even “variolation now or more sophisticated techniques later”. It’s variolation against all of the less stupid ways to make a vaccine and make it sooner.

          3. The Nybbler

            It’s variolation against all of the less stupid ways to make a vaccine and make it sooner.

            Nobody with the ability to use any of those less-stupid ways has shown any particular interest in making things sooner, at least not since some early press releases.

          4. Lambert

            Who are you expecting to be doing the variolating? People who are not able to kill all the viruses in a sample?

            At least with smallpox you have the low-tech solution of snorting a crushed up scab. How do you expect to reliably give people a small dose of SARS-COV 2 without aseptic technique?

          5. John Schilling

            “Showing a particular interest in making things move sooner”, doesn’t make things move sooner. For that, you have to convince the FDA to waive at least some of the rules against making things move sooner. I expect the reason most of the people engaged in vaccine development aren’t showing any interest in that, is the same reason I don’t generally show my interest in e.g. not paying taxes.

            If you are interested in making things happen sooner, and you think there’s any significant chance of that happening, then going to the FDA with any vaccine development plan other than variolation and asking “under these emergency circumstances, can we make this happen sooner”, is more likely to succeed than going to the FDA and saying “I want to try this old technique that was abandoned more than a hundred years ago due to the safety issues and I want you to waive some of your safety rules in the name of speed”.

            Ability to convince regulators to step aside so you can move fast and maybe break things, is specifically one of the ways variolation is stupider than every other way of developing a vaccine. Take whatever lobbying-fu you think was going to let you convince the FDA to let you do quick & dirty variolation, go to any of the other people doing less-stupid vaccine development programs, and offer to lobby the FDA on their behalf.

          6. The Nybbler

            Variolation can be accomplished by people who don’t go to the FDA; that is, who do it entirely illegally. That is its sole advantage.

            Going to the FDA and asking them to speed things up is a waste of effort; if it were possible, the actual vaccine makers would have done it already.

          7. John Schilling

            Variolation can be accomplished by people who don’t go to the FDA; that is, who do it entirely illegally.

            To what purpose? If you’re just looking for a way to protect yourself from COVID-19, masks hand sanitizer and social distancing are safer and more effective than any homebrew variolation. If you’re looking to meaningfully contribute to ending this plague, or to create a community in which you don’t have to socially distance yourself from everyone, or just to do Purplehermann’s 500-person trial so you can know that variolation works, then you are correct, you don’t have to go to the FDA for that. They’ll be coming to you.

            Anything that looks like you giving people the medical advice to get themselves infected with COVID-19, organizing a collective effort to that end and actually going out and doing it on any but the most trivially insignificant and irrelevant scale, is going to get you thrown in jail. If it’s just spitballing on the internet and hoping someone else actually organizes the effort, sure, you can do that under the aegis of the 1st amendment, but nobody else will step up to organize the effort because then they’ll be the ones going to jail. So what are you trying to accomplish here, and how do you expect it to happen?

          8. The Nybbler

            I won’t be doing anything, since I’m terrible at organizing things. But there are people who are good at organizing who might be able to make a go at variolation without getting thrown in jail right away. Hell, I’m not even deliberately infecting oneself is illegal, except in the way that everything’s illegal nowadays — specify the act and a prosecutor can find a law.

          9. Purplehermann

            @John Shilling

            First, if the dose can’t be controlled then the whole “low dose” idea doesn’t work, so I’m assuming it. Inactivated vaccines seem to have a higher chance of immune enhancement than an actual infection.

            Second, no one needs to die or go into ICU to check if the cases seem to be much lighter than usual. Cases aren’t binary – “dead 0 alive 1”.
            If it shows promise (not just “nobody died”…) in the first trial, a trial with a broader pool would be acceptable.

            I’m not sure why you are a priori assuming the spread from know infected people can’t be contained, the opposite seems intuitive to me.
            (You can variolate by household, make “Hero Hotels” like Hanson has proposed, etc..)

            As for doctors and nurses working with coronavirus patients, they are already working with coronavirus patients. They could benefit from variolation policies in particular – they’re already at risk.

            Please explain to me why you think immune enhacement risks are not a serious disadvantage to vaccines compared to natural infection, which are a big reason for longer testing schedules.
            Doing anything to change the way the virus works means a chance of something going wrong in a way wild infections alone wouldn’t.

            Right now “nothing” is exactly what is being done for doctors and nurses dealing with infected patients. (Obviously they are taking precautions, but no immunity)

            “Nothing” has been and is being discussed as a legitimate herd immunity strategey in multiple countries

          10. albatross11

            I think the best-known instance of immune enhancement is from dengue, and there, it happens as a result of the disease. You get one strain, and then I think you’re protected from future infections with *that* strain, but future infections with one of the other strains usually makes you sicker. I think the way this works is that the virus becomes a lot more serious if it can infect macrophages (cells in your adaptive immune system). Macrophages ingest things that have antibodies stuck to them. If the antibodies have stuck to the virus in a way that prevents it from effectively infecting a cell, then you get immunity, but the antibodies to the wrong strain don’t prevent the virus infecting cells, they just attract vulnerable macrophages so the virus can infect them.

            Is there some reason to think that enhanced infections are more likely as a result of vaccination than infection? I’ve never heard of a reason, but I’m certainly no expert.

          11. Purplehermann

            Yes.
            Live attenuated vaccines rely on creating a different strain, and hoping it confers immunity to the original apparently.

            Dosing is using the same strain.

            Beyond that, if enhanced infections were as likely from prior wild infections, why would human testing be such a big deal?

            People are getting exposed multiple times all around the world in high numbers, if the experimental vaccine risk was no larger than the virus risk to an individual, why the strict testing – if it’s no worse than getting infected?

        2. Edward Scizorhands

          Variolation has the advantage that you can try it on day 1. We are well past day 1.

          1. John Schilling

            This also. It’s not much of an advantage if you’re going to do the full year-plus of testing that is the current standard, but if you’re in a tearing hurry and you are starting from scratch, variolation would be a bit faster.

          2. Lambert

            You can try whole-virus vaccines on day 1+ however long it takes to boil some SARS-COV 2 (like 5 minutes if your kettle is slow?)

          3. albatross11

            +1

            Inactivating virus isn’t all *that* hard–people do it with heat and chemicals all the time. Heat-inactivated COVID-19 + adjuvants injected into your bicep probably has a pretty good chance of getting an immune response, and essentially zero chance of giving you the disease. OTOH, producing enough virus to vaccinate everyone may be a big engineering problem.

          4. matkoniecz

            Are you sure that it is *that* easy and 12-18 months minimum for vaccine is just wasting time?

            I would expect that properly inactivating (proper immune reaction, low infection rate), selecting proper adjuvants, low rate of side effects and all other things are actually not so easy.

            And that mass scale production is not a sole issue.

          5. Clutzy

            12-18 months is clearly an untenable timeline. Its up to the pro vaccine folks to figure out other plans that are not insane.

          6. Garrett

            > OTOH, producing enough virus to vaccinate everyone may be a big engineering problem.

            I’m not sure that matters in the short-term. The biggest immediate hurdle from the inside right now is the lack of PPE for critical healthcare workers, trying to keep their whole staff from being out sick at the same time or being spreaders to other patients. If we’re able to get a good number of relevant healthcare workers immunized such that they no longer require the extensive PPE and can then fall back to standard precautions/BSI (of which I think we have adequate supplies) we’re then able to care for more people in the hospitals more efficiently and can focus more on the next hurdle.

            Combined with a minimally-risky test which can determine immunity (eg. serum antibody levels) would allow for significant improvements in our ability to manage this, even if at the hundreds-or-thousands of doses a day rate.

          7. Edward Scizorhands

            12-18 months is the time to watch for side-effects. Is it any different for variolation or vaccine (or using a weakened strain, like elsewhere on this page)?

            The time for variolation was January or February. Our medical system was not under strain and we could have watched the initial volunteers extremely closely.

          8. The Nybbler

            12-18 months is clearly an untenable timeline. Its up to the pro vaccine folks to figure out other plans that are not insane.

            Not as long as they have power. It it apparent to me that the public health establishment thinks that lockdowns until a vaccine is developed (and without cutting any corners, cowboys) are perfectly acceptable. And for now the politicians are going along, because ruling arbitrarily and capriciously by decree is the highlight of their careers.

          9. albatross11

            Getting a proper vaccine takes that long because you need to verify that it doesn’t make people sick and that it gives good protection. You can speed that up a lot with a challenge study (intentionally give the subjects the virus–basically what you’re trying to do with variolation, but you do it after you’ve tried the vaccine on them and given them time to get an immune response).

          10. albatross11

            TheNybbler:

            I think elected officials are in over their heads, trying to figure out what to do in an untenable situation. The lockdowns are being advised by a bunch of respected experts and the governors and mayors are basically all guys with a law degree who don’t remember what a mean is, so they’re not reading epidemiology papers on pandemic modeling and trying to reason about them.

            The universe has served us all up a nice, steaming shit sandwich, and the fact that some of the stink has landed on you isn’t actually because of the malevolence of the authorities. To some extent, it’s due to the incompetence of the authorities and the brokenness of our institutions, but most Western countries’ institutions and authorities aren’t doing so well right now, either–we seem to be about the middle of the pack overall. Would this have gone better if all the powerful people were 20% smarter and 20% better-informed about science? Probably, but everything else would go better in that world, too. We elect a bunch of third-rate used car salesmen and reality TV stars to positions of power here, so the smart people can go into science or technology or finance.

  77. Yovel

    Re: Iran:
    The opposition organization Mojahedin Khalgh have estimated 23,100 dead in Iran [1], about six times the official number. I’m not sure they are absolutely reliable, but they were the source for some important leakages, including exposing the Iranian nuclear weapon plan, so they have at least some credibility. Plus they have boots on the ground, which nobody else does.
    The WHO estimated the Iranian dead as 5 times the reported number [2], and it has been leaked that the Israeli inteligence estimates the ratio as 4 [3].
    So while the exact number is not clear, it is clearly extremely underestimated.

    [1] https://twitter.com/Mojahedineng/status/1248294785745440768
    [2] https://en.radiofarda.com/a/who-official-says-iran-death-toll-potentially-five-times-higher/30492491.html
    [3] https://www.maariv.co.il/journalists/Article-758979

  78. bean

    An aircraft carrier captain publicly complained that the Navy was failing to address an epidemic aboard his ship; the Navy fired him for whistleblowing. I’m having a hard time thinking of any perspective other than “the Navy is bad and should be torn down totally to the foundations, preferably using some sort of land-based weapon so they can’t fight back”, but here’s a different ex-captain trying his best to give a nuanced perspective.

    First, using a land-based weapon won’t really help these days. They have Tomahawk (series coming next month) and aircraft carriers.

    I think Modly had no choice but to relieve Crozier for the reasons McGrath lays out, although it could have been handled better. Writing something like that in a way that’s likely to lead to disclosure to the media (we don’t pick idiots to command our carriers) is not something they can let him get away with, unless they want to allow the Navy to be dictated to by every O-6 who can make himself look sympathetic to the media. (Not Crozier, but there are some really weird Captains in the Navy.) Suspending Crozier pending investigation would probably have been better from a PR point of view, but I wouldn’t have second-guessed Modly before his speech a couple days ago. (Note that McGrath’s thread was pre-speech.)

    The big problem for Modly was the speech he delivered to the Roosevelt’s sailors, which was the most spectacular example of political suicide I’ve ever seen. His direct attacks on Crozier in front of a very sympathetic audience were the sort of thing that make me very confident in his complete lack of judgement. There are lots of things he could have done to put out or at least dampen the fire, and he instead doused himself in gasoline and jumped in.

    The Navy is definitely not in a good place right now, and the SecNav position in particular is increasingly looking like a singularity of stupidity. But the proper response is to find a better SecNav, not to destroy the entire Navy. (Yes, I am available.) If that’s not an option, I suspect that a cabbage would be the proper choice to the string of people who failed to be better than that. (Mabus, Spencer and now Modly.)

    1. tgb

      I’m sympathetic with Modly having to relieve Crozier for reasons that don’t his innocence into account and I’m also annoyed seeing the misrepresentations of his speech in media (he did not, in fact call Crozier stupid, and the fact that everyone seems to think he did makes me sad because it means you cannot use even slightly nuanced sentence structures without being misread. Is an “If A then B” statement too complicated for everyone? That’s not the same as saying that B is true, particularly when you’re next statement is that A is not true. Modus ponens versus Modus tollens, etc.).

      But the part where he blames China belies Modly’s bad intentions and I haven’t seen it called out. The whole “China lied about how bad this was so we can’t be blamed for failing to respond” argument is political hogwash. It was abundantly clear that the threat was real and that a serious response was needed due to the numbers we did get from China, if they lied it was no excuse to not respond. That’s like blaming the weatherman for you not taking an umbrella since they only said there’s an 80% chance of rain.

      1. HeelBearCub

        The argument about Modly’s statement about Crozier applies just as well to Modly himself.

        But then the conclusion would be that Modly is an idiot, unless you somehow how believe his intention was for the audio of this speech to leak. So, I don’t think “he was just making a nuanced argument” really flies.

        1. tgb

          Modly was stupid to make that speech but the part being quoted was just a “nuanced” (if it even gets that far) argument that everyone else (intentionally?) misconstrued. It’s the second half of the statement that frustrates me more because I expect Trump-appointees to torpedo their careers in an idiotic explosion but I want to hold the rest of us to a higher standard than that. And it’s not a high standard, this is like 8th grade reading comprehension level.

          1. HeelBearCub

            It doesn’t matter that the part of the speech quoted was nuanced. It was nuanced in precisely the way the statement itself states is deliberate or idiotic. It is self defenestrating.

            “For thee but not for me” is always a bad look.

        2. DaveK

          yes, it was an extremely ironic case.

          Roughly paraphrasing- “If Captain Crozier was naive or stupid enough to believe his letter wouldn’t get leaked to the media in the information age we live in..” As Moldy clarified, he didn’t think Crozier was stupid, meaning he believed it was Crozier’s intention that the letter be leaked, which Moldly was trying to cite as a reason his dismissal was neccesary beyond just “he violated the chain of command.”

          The irony of course being this means Moldly himself is too naive or stupid to be the Navy Secretary as it didn’t occur to him that the audio of his own speech would get leaked.

          I think the whole “the information put the crew in danger because China realized the ship had limited capacity” doesn’t pass the smell test. It stretches beyond belief to think that China would invade Guam or something just because the carrier dedicated to defending it had limited operational capacity.

          You could make an argument that what he actually meant was too specific to be clarified. That right now China is taking advantage of the relative weakness of the US. For example, some weeks ago the Navy tried to send some ships through an area of the Ocean China had claimed and built artifical islands to protect (in order to establish that China’s claim was invalid and that the US would not respect it), and China used sound and electronic weapons to repel the Navy and they had to turn around, meaning the mission failed. So the actual reason could be something like “letting China know this ship and other might be having issues that would effect their operational capacity might embolden them to assert their power more then they are already doing”, which might not be something you would want to make publicly explicit. The “too naive or stupid” argument still applies to Moldly unless his intention was for the audio to get leaked. Even then, failing to realize it would be misrepresented still leads to the “too naive or stupid” conclusion.

          The other “actual” motivation for the sacking that I could think of has to do with precedent.

          If Crozier demanded help for his crew, other commanders of military forces might be emboldened to do the same, which WOULD have a pretty big impact and potentially put troops in danger (image troops in places like Iraq or Afghanistan where Islamic militants might be emboldened to strike.) Again, this rationale isn’t something you could state explictly, as it would be a self fulfilling prophecy.

          To be clear, I’m not arguing in favor of the sacking or of Moldly’s speech, rather thinking about what the Navy and Moldly might have been thinking.

      2. bean

        One of the things someone at Modly’s level should know is the potential for bad soundbites, particularly when delivering a speech to a hostile audience on a matter that you’re under substantial public fire on. He chose to say what he said anyway. For that matter, “Either Crozier was an idiot for thinking it wouldn’t leak, or he committed a serious UCMJ violation” is really only marginally better than “Crozier was an idiot”.

        The rest of the speech was just confused, like it was half written by a good speechwriter and half either off the cuff or by someone trying to destroy Modly. Things like “Imagine if every other CO also believed that the media was also the proper channel to hear grievances with their chain of command under difficult circumstances. We would no longer have a Navy. And not longer after that, we’d no longer have a country.” pretty much needed to be said. But that should be early on, and coupled to a “More in sorrow than in anger” tone about Crozier, not bringing up stuff about how (for instance) he dropped the Governor of Guam in it. Likewise, “it’s good that you love him, but you’re not required to love your leadership” is incoherent and doesn’t actually make any point Modly needed to make. The thesis of the speech basically should have been “The proper order of priorities for a military force is mission, men, self. Crozier lost sight of that, and got 1 and 2 reversed.” But written by a better speechwriter than me.

        1. tgb

          I agree that Modly was dumb to make the speech and should have known that it would end badly. However, I don’t think that excuses people/media from not having the very basic skill of understanding such a simple argument (or of intentionally taking it out of context to deprive others of that). I really want to live in a world where politicians can make statements with conditionals in them without being misunderstood.

          1. bean

            I can sort of see where you’re coming from, but I don’t think most of the blame lies with the media. There are ways to make a nuanced argument that people will understand as nuanced and there are ways to make it so that they ignore the nuance. Guess which one he did? Specifically, if you say something as inflammatory as the “stupid or naive” bit, people are going to ignore most of what’s around it because they’re too busy watching the fire. This is just kind of how most people work, and good practice if you’re making a nuanced point is to make sure you don’t set half your sentence on fire.

          2. DavidFriedman

            @tjb:

            My reaction as well, as I think I said in an earlier comment. Any writer who, having read the speech, claimed that Modly said Croizier was naive or stupid was lying.

    2. J Mann

      Does the Navy have competent Communications/PR department? It seems like this is the kind of situation that they should be handling.

      1. bean

        The Navy’s never been great at PR, but in this case I think it’s less that and more Modly deciding to take matters into his own hands. The speech has some really good parts and some really bad parts, and the bad parts look like something he came up with on his own. There’s not much a PR department can do if the boss decides to say something stupid.

        Edit: That said, Kenneth Braithwaite, whose name has been submitted to the Senate for the SecNav job, spent most of his naval career in public affairs. If he’s willing to stand up for the Navy (he’s close to Mark Esper, the SecDef, so I’m a bit skeptical on this) he could be just what the Navy needs to turn its image around.

    3. eremetic

      I think Crozier was probably deliberately committing career suicide in order to change the situation, no?

      1. bean

        I think that’s exactly what he was doing, and I salute him for his moral courage in doing so. But I also don’t really want to let him off the hook, because it normalizes going to the media when you have problems in your chain of command. That is a very bad thing, and making it less taboo means that we’ll have people doing so when they don’t have equally good reasons for it.

        1. Eric Rall

          Relieving him of command strikes me as a pretty well-calibrated punishment. It’s severe enough to send a clear “seriously, guys, don’t do stuff like this” signal, but he isn’t getting court-martialed, demoted, or even (as far as I know) formally reprimanded, so the door should be open for the Navy leadership to rehabilitate him a year or two down the road.

          1. Matt M

            Being relieved of command is a big deal. It means his career is effectively over. He will be shuffled to some boring desk job, there is zero chance he’ll ever be promoted again, and he will be strongly pressured to just go ahead and retire.

            Now yeah, that’s hardly the worst thing that can happen. They aren’t throwing the book at him in any sense. But they are basically saying “You need to go away” on the strongest terms they possibly can without having to launch some sort of formal disciplinary procedure where the lawyers all get involved.

        2. Simon_Jester

          You don’t want military officers going to the media with problems in the chain of command when the chain of command is competent.

          But sometimes the problem with the chain of command is “the people appointed at the top are nincompoops.”

          Suppose your military is in the process of being disabled by massive coronavirus outbreaks aboard its most powerful warships. Suppose the president isn’t doing anything about it because he’s afraid his balls will fall off if he admits there’s a problem. Suppose the SecNav he’s appointed is supporting this approach because he’s a sycophant chosen largely on the basis of how good he is at flattering the president.

          At some point, this becomes the kind of problem the public SHOULD be aware of, because “the politicians we elected and the commanders they’ve appointed to run the military are making decisions so profoundly bad that it’s compromising national security” is a pretty important piece of information the public should be aware of when the next election cycle comes around.

          1. Clutzy

            Just FYI, most grunt level people I know have said we have an Admiral problem for a decade+ The rot at the top of the armed services is widespread and well known.

      2. DaveK

        Reading the wording of the letter, it seems clear he was inspired by his ship’s namesake, Teddy Roosevelt, who wrote the “Round Robin” letter under comparable circumstances.

        When Crozier was waying his options, that bit of history likely influenced him. As it turned out for Roosevelt, the letter was not career suicide, but different cirucmstances.

        Another note- the military reactions I have seen have been split, although often along partisan lines and it’s difficult to tell because of the issue of representative sampling. For what it’s worth, most of the publications aimed towards military members struck a sympathetic tone, although that may have been due to PR calculations as opposed to actual sentiment.

    4. sharper13

      Crozier knew what he was doing. He copied 20-30 extra people on his letter. He was also infected, so was likely going to be relieved soon no matter what.

      The fact that Crozier had been in frequent contact with Modly’s chief of staff, even on the day he sent the letter, and had been given Modly’s personal cell phone number to call if he wanted to raise additional concerns argues that the Navy wasn’t simply ignoring him, which would’ve been the only possible justification in my mind for going public.

      In reality, it appears that all he accomplished was to make any potential enemies/attackers aware his carrier group was crippled, while making himself and the Navy look bad in general. Hardly a recommendation for continued command.

      1. DaveK

        “in reality, it appears that all he accomplished was to make any potential enemies/attackers aware his carrier group was crippled, ”

        That rationale strikes me as implausiable. As I said in another comment, there very well may have been other more logical motivations for his firing which wouldn’t have worked to air publicly, but the idea that China was going to decide to attack his ship specifically just because of this news stretches credibility.

        1. LesHapablap

          I don’t think it stretches plausibility to say that if China has evidence that US forces are weakened they might get more aggressive in the south china sea. Obviously if every US ship that ends up with coronavirus is taken out of action then soon the whole navy will be out of action temporarily.

          1. Simon_Jester

            Given that the Chinese themselves, even if they’ve got coronavirus cases down to a minimum right now, realistically have to be worried about a resurgence…

            This would be an extremely bad time for them to start indulging in acts of war. Nobody wants to have to fight a war and deal with a pandemic at the same time.

            A falling meteor shower sinks all boats.

        2. sharper13

          There’s a reason unit readiness information is considered a secret. Surely you can appreciate why that would be in general….

          … and thus to apply that general order to this specific case is pretty straightforward.

          Sure, do we know of a specific threat from a specific enemy against his specific carrier group (not just his ship)? No.

          But then, we wouldn’t, would we? We also wouldn’t know about plans enemies might have for say, taking over more of the spratley’s, etc… which would be encouraged by knowing the U.S. doesn’t actually have a carrier group which is in a position to respond or help our allies, etc…

          It doesn’t have to be about an attack on China directly on his specific carrier.

      2. John Schilling

        Guys, the Chinese have satellites. And spies and SIGINT and all the rest. They already know which US carriers are tied up at the dock, and which ones are offloading their crews into quarantine facilities ashore. If you want to say that Crozier deliberately or negligently mishandled classified information, then that’s technically true in the way that the whole “But her Emails!” thing is technically true. And in both cases it should probably result in that person being disqualified from command as a matter of principle. So, mission accomplished.

        But if the claim is that Crozier actually endangered national security or emboldened our enemies, then no, not that.

        1. LesHapablap

          You clearly know a lot more about this than me, but didn’t Crozier publicly pressure the Navy into changing their COVID strategy to one that takes ships off the line? Successfully?

  79. RC-cola-and-a-moon-pie

    Does anyone know if this radical “distancing” regime that is implemented to address the coronavirus is having the incidental effect of drastically reducing the rates of flu and other communicable diseases during the time it has been in force? It would be nice if at least a silver lining was a large reduction in non-coronavirus death and suffering from these sorts of contagions.

    1. HeelBearCub

      It’s going to decrease pretty much most communicable disease.

      I’m sure there are some specific diseases that are exacerbated, due to their specific nature, but I would have to think that’s the small minority.

    2. The Nybbler

      Yes, according to networked digital thermometer company Kinsa. Their map shows that even in Queens, NY (the county worst hit by COVID-19), total influenza-like illness (I presume really just fever, as that’s all they can meaure) is below normal.

      1. Jake

        How much of that can be explained by a larger percentage of healthy people taking their temperatures just to see though? I’d be interested in seeing that as a total number of people with a high temperature, instead of a predicted percentage.

      2. Douglas Knight

        It’s below average, but is it abnormal?
        There’s a lot of variation from year to year. If the flu came and went early this year, then it would be low compared to other years at this time, but that doesn’t mean much.

        The CDC Flu Dashboard has data from the last 20 years. Different years are on different schedules. This season peaked in week 4, before social distancing. That’s early, but it’s not extraordinary; the 2017-2018 season looks similar. (The upper right corner shows visits for influenza-like-illness (ILI), which includes covid, while the lower right corner shows absolute numbers of positive flu tests which doesn’t. They diverge in the past few weeks.)

    3. nupi

      Apparently it also reduces ER admissions because of accident related trauma which by extension must do something on accident related deaths, too. Sorry, hearsay so far but I am sure we will get data on that.

    4. DaveK

      The policies in theory should also lower many causes of fatality, like traffic accidents.

      I read something about how reduced pollution probably will save a lot of lives.

      I would guess the tradeoff there might be some people are forced to more sedentary, and in the long run mental health effects, particularly for those who live alone without partners or families.

      1. HeelBearCub

        Traffic accidents are quite likely lower. I think fatalities will be confounded in many cases by the increased speed of the accidents which do occur. I’ve seen anecdotal evidence that this has occurred in MN, although I didn’t check it myself.

  80. Alsadius

    Regarding mail-in voting, remember that the ballots also need to be counted. If you can’t put several people in a room(at the very least, one counter and a couple scrutineers), you can’t count mail ballots, even if people cast them.

    As for the political angle on it, the usual complaints I see about it from the right side of the political spectrum all boil down to fraud. It’s easier to fake your identity/citizenship/felon status/etc. if you’re using ID sent by mail than if you have to show up in person.

    Here in Canada, we get voter cards sent by mail every election. These aren’t ID(they’re more to tell us about polling locations etc.), but they are sent out based on where Elections Canada thinks you live. And mine have been right about half the time, in practice. Part of that is that I’m younger(34) and have moved a fair bit, but more than once I’ve gotten cards for other people, or my cards have never shown up. So clearly, the system we have now is not sufficient to tell who lives where, despite Canada typically being not-too-bad at that kind of thing. You will need to add on the ability to say “Hey, I’m a new voter [or I moved, or whatever] – please let me vote from my new place”. And then prove your identity with a piece of paper, where they can’t easily check for fake ID.

    We also had a party leadership election a few years back, where one of the candidates had the support of the party apparatus, and a lot of volunteers for his leading opponent never got ballots in the mail, despite calling in to complain repeatedly. I don’t know if this was fraud or incompetence(it could really have been either with that group), but it really left a bad taste in the mouth of the supporters of the latter candidate when he lost in a close race.

    Obviously, the counter-argument here is that fraud is super-rare. The gold standard for fraud investigations(at least, so far as I’m aware) in the US in recent years was the 2004 Washington governor’s election, where the legal fighting resulted in a judge declaring 1,678 illegal votes having been cast, in a race with 2,810,053 total votes, or about 0.06%. I think they only checked about half the votes cast(since it was mostly Republicans making this argument, they only looked at counties the Democrat had won), so it might be up to 0.1%. And this was only the kinds of fraud that could be proven after the fact – mostly felons, with a few double voters and dead voters. So any fake-ID voting that was successful wouldn’t be in these numbers. Still, 0.1% is a pretty small amount of fraud as these things go, especially since a lot of them are honest errors (not systematic fraud efforts) that could largely cancel each other out. So perhaps they invest too much effort in worrying about it. But the number is clearly higher than the ~10 cases in the US per election cycle that actually result in criminal charges. What to do about it, I’ll leave as an exercise to the reader.

    1. EchoChaos

      There are a couple of other concerns with mail-in voting that are harder to detect.

      The first is that it vitiates the secret ballot. A polling place legally must have poll watchers and ensure that you aren’t having someone go in with you unless you specifically need aid. Elsewhere it’s much easier to do “Honey, prove to me you voted for Trump”.

      The second is that combined with ballot harvesting (legal in some but not all jurisdictions with mail-in) it allows outsized and completely impossible to scrutinize turnout operations that specifically benefit Democrats. Even if you just harvest ballots and don’t do any pressuring, Democrats tend to live in tighter quarters, which means that ballot harvesting “Fill it out and I’ll mail it in” will benefit them per unit time.

      1. Alsadius

        Fair. FWIW, there have been some cases of Republican ballot harvesting (North Carolina had a case last election, IIRC, despite it being illegal there), but it probably advantages Democrats overall in the US context.

        1. EchoChaos

          Fair. FWIW, there have been some cases of Republican ballot harvesting (North Carolina had a case last election, IIRC, despite it being illegal there), but it probably advantages Democrats overall in the US context.

          To be clear, both sides do ballot harvesting (and probably both do illegal ballot harvesting), but Democrats get more bang for their buck out of it. Driving to each house in a suburban neighborhood takes more effort than canvassing an apartment building.

          And NC making it illegal is the only reason that voter fraud was detected. If ballot harvesting had been legal, that would’ve been completely undiscoverable.

      2. DeWitt

        I don’t really know of a good way to completely assuage the secret ballot concern, but what keeps the US from mandating a federal ban on ballot harvesting to deal with the second?

        1. EchoChaos

          but what keeps the US from mandating a federal ban on ballot harvesting to deal with the second?

          The Democratic Party.

          1. DeWitt

            The Republicans just recently came out of a good few years in which the Democratic party has been toothless, so I’m going to want you to source such a claim.

          2. EchoChaos

            @DeWitt

            Is joke. You laugh.

            Seriously, I’m being relatively flip, but at no point have the Republicans had a filibuster-proof majority at the Federal level in the past decade.

            Additionally, given that each state runs their own elections, there would be some strict scrutiny if the Federal government even had the right to mandate such a thing.

          3. Simon_Jester

            @EchoChaos

            The problem with laughing off @DeWitt ‘s question is…

            Did the Republicans even [i]try[/i] to pass legislation banning ballot harvesting? Do you have evidence that Democrats even threatened to filibuster such legislation?

            I can very easily picture Democrats agreeing to that, especially in the context of a broader compromise bill that makes mail order voting in general more feasible but also tightens up provisions to avoid actual (as opposed to imagined-as-excuse-to-avoid-letting-people-vote) fraud issues.

          4. EchoChaos

            @Simon_Jester

            Did the Republicans even [i]try[/i] to pass legislation banning ballot harvesting?

            Yes, Republican states have banned it (e.g. Texas, Arizona, North Carolina) and Democrat states have legalized it (e.g. California).

            Arizona’s is still under court challenge from Democrats.

            There is no Federal law because there is no “Federal vote”. All votes in the USA are adjudicated and decided at the state level. It hasn’t been a Federal issue until very recently because it’s just a very recent thing.

            I can very easily picture Democrats agreeing to that, especially in the context of a broader compromise bill that makes mail order voting in general more feasible but also tightens up provisions to avoid actual (as opposed to imagined-as-excuse-to-avoid-letting-people-vote) fraud issues.

            I can’t. I’ll betcha a nickel that Democrats don’t offer a vote harvesting ban.

          5. DavidFriedman

            I was curious about exactly what ballot harvesting was, so googled for it and found a news story that quoted the relevant bit of California law. What struck me is that there is no requirement that the ballot be sealed before it is handed over to someone else to hand in. That makes it trivial to use ballot harvesting for fraud — just collect lots of ballots and only hand in the ones that vote the way you want. And doing that on a scale of hundreds of votes would only require one person acting where nobody else could observe the fraudulent part of what he did. Have a bunch of people collect a thousand ballots, hand them to one person to hand in, he goes over them in private and trashes the ones he doesn’t want to hand in.

            I would think that requiring the ballots to be sealed, ideally in some way that made unsealing and resealing hard, would be the obvious precaution for anyone who wanted to make voting easier without making fraud easier.

          6. nkurz

            @DavidFriedman:
            > requiring the ballots to be sealed

            While this is probably an improvement, I don’t know if it would help that much with fraud. Even if you can’t verify the ballots directly, probabilistically eliminating ballots based on demographics gets you most of the benefit. Simplistically, you could just collect ballots from a neighborhood that historically votes for your opposition, and throw them all away. It would seem much safer just to ban the practice altogether.

          7. Simon_Jester

            @EchoChaos

            Under present circumstances it would be fairly easy to create a federal law regarding ballot harvesting.

            “Due to the coronavirus outbreak we are giving each state X dollars per registered voter in the state in 2018, for the purpose of setting up infrastructure for universal mail-in voting. This money will only be distributed under the following conditions:”

            1) [Antidiscrimination boilerplate ensuring that a state cannot, for instance, ‘forget’ to pass out mail order ballots to specific groups of voters]

            2) …
            3) …

            N) No person shall mail a ballot on behalf of another person, unless they sign two statements representing that they will faithfully mail in that ballot. One will be left with the voter, and one enclosed with the ballot.

            Then you hold the election. If the Republican Party is worried about people harvesting ballots and conveniently leaving out the Republican ballots, they send someone around with a clipboard a few weeks later (or take advantage of their existing mailing/email/phone/etc lists):

            “Hey, Joe Redhat, did you mail in a ballot?” “Yep.” “Did you send it in yourself?” “No, I gave it to Bob Sleazydonkey.” “Did he give you a receipt?” “Yep.”

            [Check to see if a receipt saying “Bob Donkey is mailing this ballot” came in with Joe’s ballot. If not, or if Joe’s ballot never arrived at all, Bob faces criminal charges]

            This exact system may not be airtight, but you get the idea. Given that we still have roughly six months to prepare, and that the federal government has plenty of tools to force states to adopt standards on something like this, it wouldn’t be hard to set up.

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

            If the Democrats don’t offer a vote harvesting ban along these lines, I predict it’s because they never get a chance because the Republicans refuse to even consider mass mail-ins of absentee ballots as an anti-coronavirus measure.

      3. nupi

        Secret ballots by mail is trivial. You put the certificate that you are allowed to vote in the envelope (needed t9 guard against double votes, etc) and then the actual vote nextyto it inside of a second envelope that gets only opened upon counting.

        This has literally been done for two plus decades in Switzerland every 3 to 4 months.

        Of course, if you cannot manage to issue certificates properly it is harder but that has nothing to do with secrecy of the ballots

        1. EchoChaos

          Secret ballots by mail is trivial. You put the certificate that you are allowed to vote in the envelope (needed t9 guard against double votes, etc) and then the actual vote nextyto it inside of a second envelope that gets only opened upon counting.

          That is also the US system in states with mail in ballots. But how do you verify that a wife didn’t fill it out with her husband watching?

          In a polling place, she goes in alone and poll workers prevent her husband going with her. When they live together, how can you do that?

          1. nupi

            With a sufficiently malevolent/violent husband (in all other cases it would seem up to the wife), you cannot. But you also cannot completely prevent malfeasance of that sort in the case of in person ballots (‘Hey, where did my car keys go?’ at least prevents her from voting)…