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.

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829 Responses to Coronalinks 4/10: Second Derivative

  1. vonnik says:

    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 says:

    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 says:

    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 says:

    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 says:

    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. albatross11 says:

    The economic news isn’t going to be good anytime soon.

    Figuring out how to get retail stores reopened without massively increasing the spread of the virus should be a big priority. That, in turn, depends a lot of whether there’s substantial airborne spread.

  7. 1 says:

    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.

  8. DNM says:

    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)?

    • albatross11 says:

      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.

    • John Schilling says:

      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”.

      • Clutzy says:

        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).

        • John Schilling says:

          Isn’t that pretty much what I said in my first paragraph?

        • Matt M says:

          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?

      • glorkvorn says:

        excellent summary.

    • The Nybbler says:

      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.

      • wonderer says:

        What would your public health policy be, if not lockdowns?

        • The Nybbler says:

          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.

          • Advise all vulnerable people to self-quarantine as best they can, and do things to make doing so easier.

          • Matt M says:

            +1

            This is really the only viable option at this point.

          • anonymousskimmer says:

            do things to make doing so easier.

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

          • DNM says:

            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.

      • albatross11 says:

        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).

        • The Nybbler says:

          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.

          • albatross11 says:

            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.

          • The Nybbler says:

            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.

  9. realist50 says:

    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.

  10. realist50 says:

    “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.

  11. Douglas Knight says:

    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.

  12. albatross11 says:

    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….)

  13. albatross11 says:

    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.)

  14. jamesliudotcc says:

    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.

    • Edward Scizorhands says:

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

    • albatross11 says:

      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.

  15. tokugawa says:

    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

    • albatross11 says:

      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.

    • The Nybbler says:

      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.

      • nkurz says:

        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?

        • albatross11 says:

          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.

    • albatross11 says:

      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.

      • matkoniecz says:

        https://en.wikipedia.org/wiki/COVID-19_vaccine “By April 2020, 115 vaccine candidates were in development”

        And promising drugs turn out to have problems al the time.

      • The Nybbler says:

        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.

        • Edward Scizorhands says:

          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.

        • The Nybbler says:

          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.

        • albatross11 says:

          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.

        • albatross11 says:

          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.)

        • albatross11 says:

          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.

        • Edward Scizorhands says:

          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.