It is the sixty-first day of shelter-in-place. Anti-lockdown protesters have stormed your state capitol, chanting Nazi, Communist, ISIS, and pro-Jeffrey Epstein slogans to help you figure out they’re the bad guys. Inside, the Governor has just finished announcing his 37 step plan to reopen the state over the next ten years. You kind of feel like he should be a little more proactive, but the protesters outside have just unfurled a Khmer Rouge flag, so you hold your tongue.
Meanwhile, a band of renegade economists, tech billionaires, and MIT professors has just announced a bold disruptive Manhattan-Project-style moonshot: send a team of researchers to the swamps of Florida, where legends speak of a Fountain of Youth whose water can cure any malady. But disaster strikes when Florida’s governor announces that exploration is not an essential activity, and threatens to release the quarantine enforcement lions. The nation looks to the White House to solve the growing conflict, but President Trump is too busy evangelizing his latest coronavirus cure: eating those little packets of silica gel in food that say DO NOT EAT. As the Western States Pact and the Eastern Bloc inch closer to war, all that the rest of us can do is strive to stay as well-informed as possible, trying to make sense out of an increasingly nonsensical situation. So:
“Jail Isn’t Real”, I Assure Myself As I Close My Eyes And Drive To The Hair Salon
Here are some CDC graphs that use cell phone data to measure percent of people leaving home over time (source, h/t Kelsey):
On this measure, official government stay-at-home orders didn’t seem to affect the percent of people staying at home, even the tiniest bit.
Facebook is tracking something similar – see their terrible and hard-to-use website here. Here are the data from California:
Can you tell what day a statewide lockdown order was issued? (click here and check the date of the article for answer).
If comparing times doesn’t impress you, we can also compare places. Sweden has attracted international attention for its refusal to shut down business – restaurants and bars there are open as usual. And Nashville has attracted attention as a center of growing anti-lockdown protests by people who think its shelter-in-place order is too strict. But cell phone data finds that citizens of Stockholm and Nashville “have nearly the exact same adjustment in driving, walking, and transit use”.
What’s going on here? On the one hand, lockdowns are poorly enforced and we’ve all seen pictures of people going to the beach unmolested. On the other hand, surely fewer people are going to work, since the offices are all closed? Surely fewer people are going shopping, since the malls are all closed? What about all those pictures of empty freeways during rush hour?
The best answer I can come up with is that most people are risk-averse and started staying at home before the official lockdown. A few risk-tolerant people didn’t, but they are disobeying the lockdown as much as they can anyway. And the cases where risk-tolerant people can’t disobey the lockdown aren’t numerous enough to show up in aggregated cell phone data.
I find this answer pretty unsatisfying, so maybe I’m just misunderstanding what the cell phone tracking data are trying to show, or how much I should expect from them. This might also be a good time to review the ongoing debate about whether reality drives straight lines on graphs, or straight lines on graphs drive reality.
Heterogeneity
Our World In Data deserves some kind of prize. I think they already have won some prizes, but they deserve better ones. Possibly a Nobel, or a knighthood, or beatification. They give you any information you want, from any country you want, and display it however you want. If you’re trying to figure things out about the coronavirus and not using Our World In Data’s tools and graphs, you’re missing out.
Here’s coronavirus cases per capita across countries, by days after the number of cases per capita in that country passed one in a million. There’s some debate over what we gain/lose by adjusting/not-adjusting for per capita, but I think this is probably the best measure of how good a job different countries are doing at containing the infection:
And here’s coronavirus deaths, by the same measure:
And to save you the trouble of having to divide the first graph by the second graph, case fatality rates:
And since all of these numbers are confounded by testing rates, here’s tests per thousand people:
You’ll hear a lot of bad takes about where America ranks relative to other countries. Ignore them and look at these four graphs. America has one of the highest infection rates of any developed country, trailing only Spain. But it has one of the lowest mortality rates of any developed country, beaten only by Germany, Denmark, and a few other of the usual high performers. It’s right in the middle in terms of numbers of tests, beating eg Netherlands and Sweden, but trailing Germany and Denmark (though it may have an “advantage” on testing since so many people are infected).
Why is US mortality rate so low? The rate could be artificially low it we were unusually good at testing, but we aren’t. It might mean our health care system is unusually good, but that doesn’t seem like us either. I haven’t heard anyone claim that our standards for reporting a death as COVID-19 are stricter than anyone else’s, and our uncategorized excess mortality doesn’t seem much different from everyone else’s. I notice that all highest-mortality-rate countries are European, and that less-developed countries tend to be lower. Maybe it’s something about density? Maybe Europe got a different strain of the virus than everyone else? I only see a few people talking about this (Kevin Drum continues his 100% success rate of having gotten to interesting topics before I did, but see aso here and here), but nobody seems to have much in the way of a theory.
[edit: bpodgursky points out that European populations are, on average, much older than the US]
How effective has lockdown been at controlling the spread of the virus? Three countries have made the news for unusually weak/nonexistent lockdowns – Sweden, the Netherlands, and Japan. All have chosen to keep most of their economy open in the name of “herd immunity”, although they’ve banned very large gatherings like concerts and sports games. If we accept Denmark, Germany, and South Korea as “matched controls” that have made more aggressive efforts to contain the disease, it’s hard to see much of a difference. Sweden’s doing worse than Denmark, but not as much worse as we might have expected. Netherlands is marginally worse than Germany, and Japan marginally worse than South Korea – but it all seems within chance variation. If we’d chosen to use Belgium as a control for the Netherlands (I didn’t because it’s recording mortality statistics in an odd way), Belgium would have looked worse. Countries like Spain and the UK which responded pretty aggressively have more cases than a lot of countries that are barely doing anything at all.
This seems to match the conclusion from the last section: government policy isn’t mattering as much as we think. We thought South Korea and Taiwan were doing well because their governments were so brilliant and competent, but Japan’s government kept denying the problem existed in order to preserve their shot at holding the Olympics, and they seem to be doing equally well.
Switzerland is another weird case. It’s a loose confederation of linguistically French, Germany, and Italian regions. Remember that France and Italy have been devastated by the virus, and Germany has mostly gotten off unscathed. The same is true of Swiss regions; French- and Italian-speaking cantons have been devastated, while their German-speaking neighbors wonder what all the fuss is about. The Swiss government swears that this has nothing to do with policy. From the linked article:
Talking to Swiss media outlet Le Temps on Thursday, the Federal Office of Public Health (FOPH) said the efforts to combat the virus were largely uniform across Switzerland – meaning other situational factors were at play.
The measures were decided at a federal level when the epidemic was already advanced in different ways in different regions,” a FOPH spokesperson said. “This has nothing to do with a difference in the extent to which different cantons have taken action.
This isn’t to say government policy doesn’t matter – just that it adds or subtracts a relatively small modifier on top of a much wider variation.
What’s going on? Various hypotheses – BCG vaccinations, smoking rates, genetics, different viral strains – have come and gone, mostly unconvincingly. Another hypothesis – time – does a little better. Countries with different levels of connection to Wuhan and different luck in terms of superspreader events had their epidemics start a month or two earlier or later. Later countries had the benefit of warmer weather and a more aware population who were already taking social distancing measures on their own regardless of what the government told them (national education level might play into this too). Then lockdown strength added a little more or less on top of this.
This explains a little. But it doesn’t explain NYC vs. the rest of the US, or Japan vs. the rest of the world. Something’s still missing here.
Voice-Activated
It’s becoming increasingly clear that a big (maybe the biggest) risk factor for coronavirus transmission is speaking. Singing is even worse. The louder you speak or sing, the worse it gets.
Some confirmed early superspreader events were choirs. A lot of others were churches, where everyone gets together and sings hymns full-blast. This person’s explanation for the surprisingly low rate of subway-mediated transmission in Japan is that nobody talks on a Japanese subway.
All this makes sense. Coronavirus has mostly droplet transmission. There are three ways to get droplets: coughing, sneezing, or talking/singing. You do one of those about a thousand times more often than either of the others.
I appreciate how much pressure there is on governors to open up churches, but they should be very careful about this, unless churchgoers can promise to stay uncharacteristically silent. I realize how bad it will look to say that golfing and rock concerts and orgies are allowed but churches aren’t. Still, governors should swallow their pride and stand firm.
(Or they could just troll people. I understand Muslims pray quietly facing the ground, so how about ordering that mosques are allowed to reopen but churches aren’t? Then sit back and watch the fireworks.)
An extremely crackpot theory – could the missing cultural vulnerability factor be how loud and spittle-filled people’s speech is? When I think of a country where people talk very loudly to each other without much personal space, Italy is on the top of my list. Then comes New York City, which muscles its way in even though it isn’t even a country. When I think of countries where everyone talks really quietly and far away from each other, I think of Japan, South Korea, and all those other Asian countries that have mysteriously escaped infection.
Are there counterexamples? I Googled “loudest cultures”, and got people talking about Australians, Africans, and Cantonese Chinese. All those places have done pretty well – though they’re all pretty warm right now, which is a confounding factor. Without being able to find some kind of official data about conversational volume, I’m not sure there’s much I can do with this hypothesis right now.
[EDIT: Commenters point to Georgians and Germans as people who speak loudly yet have avoided coronavirus epidemics]
Love In The Time Of Coronavirus
One of my housemates lives two blocks away from her boyfriend, and hasn’t hugged him in three months. A friend lives a town over from his parents, and hasn’t been able to visit them since March.
Meanwhile, government offices and the media are all talking about how to get hair salons to reopen as quickly as possible, and making detailed lists about what kind of golf courses are or aren’t okay. The governor of California has a four phase plan that discusses exactly what criteria need to be fulfilled before we can have fitness centers, swimming pools, and rock concerts – but not a word about when you can hug your loved ones.
Probably the government just assumes everyone is already breaking those rules and there’s no point in worrying about them. I think this assumption generally holds. My patients are mostly law-abiding upper-class liberals who think of the lockdown protesters in Michigan as basically death cultists – and almost all of them casually let slip that they’ve gone over to their parents’ for dinner, or visited their partner, or even had small gatherings with close friends. The cell phone tracking data is equally pessimistic about the lockdowns reaching too far into the private sphere.
But some people are genuinely law-abiding. Fewer all the time, now that they’ve spent months shut off from everyone they love, while watching everyone else go to the beach with their buddies and face zero repercussions. But the government should acknowledge that these people exist and try to support them. Give the slightest acknowledgment that in between declaring marijuana dispensaries an essential activity and saying that even though nobody else is allowed to work Elon Musk can reopen his Tesla factory because he’s famous, someone is also making a plan for when you can see a friend again. Even something like “once we reach Phase 2 of the reopening, you may visit one person outside your household per week” would ease a lot of people’s misery. Even if this isn’t the best idea from a epidemiological standpoint, they should do it anyway, because otherwise people will visit people outside their household and lose all respect for the law in general.
Information Wet Markets
At last, coronavirus prediction markets have arrived. Check out CoronaInformationMarkets.com and start investing, unless you live in the United States which is an authoritarian Nazi communist Luddite hellhole and bans you from contributing. Some highlights:
“What percent of the global population will be estimated to have contracted COVID-19 by the end of 2020?” – LESS THAN ONE PERCENT is at 11%, BETWEEN ONE AND THREE PERCENT at 18%, BETWEEN THREE AND FIVE at 39%, and GREATER THAN FIVE at 32%.
“Will hydroxychloroquine be approved as a treatment for COVID-19 by the FDA by October 1 2020?” – YES has 32%, NO has 68%.
And “Will a vaccine be approved before the end of 2020” – almost exactly split, 48% YES, 52% NO.
If you’re too chicken to bet real money, or you live in a fascist antiintellectual statist kakistocracy like the US, you can go to Metaculus, which continues their great work soliciting and aggregating predictions made with fake Internet points.
“When will a SARS-CoV-2 vaccine candidate that has demonstrated an efficacy rate ≥75% in a n≥500 RCT be administered to 10M people?” – median guess, October 10, 2021
“When will the Dow Jones set a new all-time record high after the coronavirus crash of February 2020?” – median guess, December 24, 2021.
“When will Disneyland reopen?” – median guess, August 29, 2020
“Will it be reported that Donald Trump tested positive for COVID-19 in 2020?” – median guess, 25%
There’s also a section on the total number of worldwide coronavirus cases in each quarter of 2020. Q1 (January 1 to April 1) saw about a million worldwide. Today we’re at 4.6 million. Metaculus thinks that by July 1, we’ll be at 7.5 million. By October 1, 9.8 million. By year’s end, 10.9 million. Except that I got those by adding results from different quarters together, and an alternative question that just asks that directly gets 16.2 million. Come on, people! Do some arbitrage! It’s almost like you’re not sufficiently devoted to winning fake Internet points!
Wash Your Hands!
Weird Sun Twitter does handwashing timing mnemonics:
When All You Have Is A Hammer, Everything Starts Looking Like A Dance
Everyone is hoping for a definitive solution to coronavirus. A vaccine, or a good antiviral, or a test + trace regimen so well-coordinated that it stops the virus in its tracks.
Suppose that after X years, we realize there is no definitive solution. We are faced with the choice of continuing restrictions forever, or lifting the restrictions, letting lots of people die, and getting herd immunity the hard way. What then?
If we lift the restrictions, the same number of people will die as if we had never instituted any restrictions at all, and also we will have wasted X years. We will have gone X years with millions of people poor and unemployed, millions of others locked in their houses and unable to have fun – and it won’t have saved a single life.
If there’s a 50% chance of a definitive solution in one year, is it worth staying locked down until then? What about a 25% chance in five years? 10% chance in ten years? If there is never a definitive solution, are we willing to stay locked down forever?
Also: if a lockdown lasts a long time, what’s the average R0 during that phase? One possibility is that it’s less than 1, in which case the virus will “die out” locally (although it probably won’t go extinct smallpox-style – too much opportunity for other countries to reinfect us). Another possibility is that it’s more than 1, in which case lockdown isn’t working and we get continued exponential growth ending in lots of deaths and eventual herd immunity.
Is there a possibility where R0 is exactly 1? Seems unlikely – one is a pretty specific number. On the other hand, it’s been weirdly close to one in the US, and worldwide, for the past month or two. You could imagine an unfortunate control system, where every time the case count goes down, people stop worrying and go out and have fun, and every time the case count goes up, people freak out and stay indoors, and overall the new case count always hovers at the same rate. I’ve never heard of this happening, but this is a novel situation.
If that were true, right now we’re on track to gain herd immunity in 30 years. This would be another worst-of-all-worlds scenario where we have all the negatives of a long lockdown, but everyone gets infected anyway.
Sing, O Muse, Of Arbit-Rage
There’s a morbid joke about the news, which goes something like:
10,000 Africans in a famine =
1,000 Chinese in an earthquake =
100 Europeans in a plane crash =
10 Americans in a terrorist attack =
1 pretty white girl getting kidnapped
(if you want to go a different direction, you can add “= 0.1 black people murdered by cops”)
Coronavirus has killed about 100,000 Americans so far. How bad is that compared to other things?
Well, on the one hand, it’s about 15% as many Americans as die from heart attacks each year. If 15% more people died from heart attacks in the US next year, that would suck, but most people wouldn’t care that much. If some scientist has a plan to make heart attacks 15% less deadly, then sure, fund the scientist, but you probably wouldn’t want to shut down the entire US economy to fund them. It would just be a marginally good thing.
On the other hand, it’s also about the same number of Americans who died in the Vietnam War plus the Korean War plus 9/11 plus every school shooting ever. How much effort would you exert to prevent the Vietnam War plus the Korean War plus 9/11 plus every school shooting ever? Probably quite a lot!
Maybe part of this is that heart attack victims are generally (though not always!) older than 9/11 victims, so the cost in DALYs is lower. But the bigger problem is that there’s no arbitrage in the market for lives. Some normal good, like Toyota Camrys, sells for about the same price everywhere. There might be minor variations based on how far you go from a Toyota factory or something, but overall you wouldn’t expect the same Camry to sell for ten times as much in one city as another. Someone would arbitrage – buy the Toyotas in the cheap city and sell them in the expensive one! But the same reasoning fails when it applies to lives. Life has no single value denominated in dollars, attention, or outrage. So when we search for metaphors to tell us how bad 100,000 deaths from coronavirus are, our conclusion depends entirely on what metaphor we use. “It’s like 15% of heart attacks” sounds not-so-bad, and “it starts with the Vietnam War and gets worse from there” sounds awful, even though they’re the same number. There’s no way to fix this without somehow making all our intuitions collide against each other and equalize, which sounds really hard.
Suppose you reopened the economy tomorrow. You tried as hard as you could to put profits above people, squeezed every extra dollar out of the world regardless of human cost. And then you put a 1% tax on all that economic activity, and donated it to effective charity. Would that save more people than a strict lockdown? If a lockdown costs $5 trillion, then the 1% tax would make $50 billion. That’s about how much the Gates Foundation has spent, and they’ve saved about ten million lives. Ten million is higher than anyone expects US coronavirus deaths to be, so as far as I can tell this is a good deal.
On the other hand, the US spent about $5 trillion on the Iraq and Afghan wars. Even optimistically assuming this helped prevent some terrorism, it’s a no-brainer to say we should have accepted the cost in terrorist attacks and spent it on stricter COVID lockdowns instead.
Is spending resources on the coronavirus lockdown a good idea? A good idea compared to what? Compared to using resources efficiently, goodness no, not at all. Compared to putting the resources in a giant pile and setting them on fire, yes, definitely. Compared to usual practice? Usual practice basically involves alternating betwen the two previous options inconsistently; the answer depends on how long we spend in each category. At this point, we are too incompetent for questions about our preferences to even make sense.
Shortlinks
The Marginal Revolution folks and the Mercatus Center are doing really amazing work to try to use economics to coordinate the pandemic response. Here’s a report by Caleb Watney and Alec Stapp about how the government should use purchase guarantees to boost production of essential medical equipment.
Patrick McKenzie of Kalzumeus, a Westerner in Japan, talks about his work trying to get them to realize the severity of the virus and take some response. Written on April 21, when Japan’s situation was at its worst and it seemed like he had presciently ferreted out an undercover epidemic. Since then, Japan has gone back to mysteriously defying gravity, so I’m not sure how to think about this now.
Mark Andreessen made waves with an article arguing that the coronavirus shows America needs to learn how to build things again. I also appreciated Ezra Klein’s response, which was that America already knows how to build things but is blocked by government dysfunction (I doubt Andreesen disagrees with this framing). Klein highlights the term “vetocracy” for all the features of modern society which give us a bias toward inaction. Clearly true and important, although a fuller treatment (which I hope to give!) would have to talk about the advantages vs. disadvantages of bias for action vs. inaction (the very end of this post can perhaps be interpreted as a paean to vetocracy). See also Mark Lutter: Build Institutions, Not Apps.
Related to the bat discussion from last post – a new paper finds that viral zoonotic risk is homogenous among taxonomic orders of mammalian and avian hosts – in other words, despite how it looks, bats don’t spread disproportionately more viruses to humans than any other animal – there are just a lot of bats. But see also this contradictory past study.
Earlier I asked whether some savvy early coronavirus investors had dealt a blow to the efficient market hypothesis. Now that the dust has cleared, I agree with this post saying the EMH still looks pretty good – although sometimes it moves in mysterious ways. Also in me-being-wrong news, evidence continues to come in about whether smoking is a risk factor for coronavirus, protective against it, or all the studies are biased and we have no idea. Something in this space will probably end up on my Mistakes page one day, but I’m going to wait until I can be absolutely sure I know what.
Everyone expected prisons and homeless shelters to be devastated by coronavirus, since they had lots of people together in close quarters and little ability to escape. Although these institutions have not had great times, they seem to have weathered the storm better than a lot of people would have predicted, mostly due to a high rate of asymptomatic infections. Why?
There was a lot of talk a few weeks about about Eastern European success at avoiding the coronavirus. Then Russia and Belarus’ case numbers exploded; both are now doing as bad as any Western European country. Poland, Romania, Czechia, and others continue to be oddly quiet. I suspect random variation – Russia and Belarus looked good until they weren’t – but I guess we’ll find out soon.
This article is kind of critical of Dominic Cummings, but the criticism is that he inappropriately pressured scientific bodies to order a UK lockdown ASAP, instead of letting the scientists take however long it took to evaluate the evidence in a proper scientific way. I like due process and checks-and-balances as much as the next liberal, but I also think you should be allowed to break the rules in an emergency and then let the people affected by your choice decide whether they want to show you mercy based on time proving you right, or punish you to the full extent of the law based on time proving you wrong. In this case he was right and deserves to be celebrated.
Some studies of remdesevir, not very encouraging. Hydroxychloroquine is basically dead in the water at this point, sorry Donald.
Some people are worried that coronavirus might be overblown and doctors are just classifying random other stuff as coronavirus deaths. The best antidote to this claim is this look at excess mortality over the average for this time of year worldwide.
You’ve probably already read this, but the story about how Trump’s premature praise for hydroxychloroquine caused some supporters to overdose on hydroxychloroquine-containing fishtank cleaner got a lot more complicated – they were actually both anti-Trump Democrats, and the woman is now under investigation for murdering her husband and inventing the hydroxychloroquine story to cover it up. This seems like one of those things which is probably a metaphor for life.
There’s been some worry about coronavirus reinfection – maybe people who have already gotten it aren’t immune and can get it again? A recent Korean study tried to put those fears to rest, showing that they were mostly testing errors. Professor Shane Crotty says he has studied the immunology of coronavirus and come to the same conclusion a- after infection, the immune system is able to create antibodies to it which prevent further infection for a while. Two data points don’t prove anything, but this is how things work with most viruses, so the burden of proof is on anyone who thinks COVID-19 is different.
Are coronavirus victims so old and sick they would just die from something else soon anyway? Two studies were recently reported as saying they would have lived at least ten more years, but read Scoop dissecting them in the comments section here.
A few weeks ago people were talking about the “iceberg hypothesis” – maybe detected coronavirus cases are “just the tip of the iceberg”, and there have been so many asymptomatic people that we’re nearing herd immunity already. Recent studies haven’t been kind to this proposal. Both France and Spain have about 5% seroprevalence, which means official counts are only off by a factor of ten, about what we already expected. It also means true mortality rate is still about 1%, also what we already expected (and high enough to result in tens of thousands of deaths before anyone gets herd immunity). No icebergs here. A Santa Clara study seemed to show 2% seroprevalence, which actually was much higher than expected and would be consistent with the iceberg theory, but Andrew Gelman is very much not impressed. Greg Cochran gives the hypothesis a postmortem here, and also is not impressed with claims that we might be able to naturally and easily achieve herd immunity before about ~70% of people are infected.
Elon Musk has reopened Tesla’s Bay Area factory. Although the rest of California is gradually reopening, the Bay Area is playing it extra careful and has asked everyone to stay home until at least June 1. Except, apparently, Elon Musk, who declared the factory was reopening regardless of what anyone said, and that “if anyone is arrested I ask only that it be me”. For some reason, the county did not arrest him, and now it seems to have retroactively legitimized Musk’s action. I like Elon Musk and I support the right to civil disobedience, but the government should absolutely have arrested him. They wouldn’t necessarily have to give him twenty years to life or anything, just arrest him enough to make it clear that there are laws and you get punished if you break them. [EDIT: see here for discussion of why he wasn’t arrested]
Nate Silver crunches the evidence and finds that (contra what I wrote last time) there is no evidence that voting by mail gives one party an advantage. So how come Democrats are so excited about it and Republicans so anxious to prevent it? Do they know something Silver doesn’t know? Or are they really and truly just concerned about their principles, with no ulterior motive?
The latest from EA on best ways to donate to the fight against coronavirus. Summary of the summary: Fast Grants and Development Media International. Fast Grants has a minimum donation of $10,000 (they are smart people and I assume there is a reason for this); some people were previously trying to pool their donations to reach this amount but I don’t know where the latest active pools are.
Coronavirus has killed 90,000 Americans so far. Donald Trump tried to put this in context by saying the seasonal flu sometimes kills 60,000 people a year. There are a lot of problems with this comparison, but one I didn’t realize is that coronavirus death toll only counts confirmed cases, whereas flu death toll counts estimated cases, ie a guess as to how many cases we would find if we had perfect detection. The number of confirmed flu deaths – a fair comparison to the 90,000 confirmed coronavirus deaths – is about 10,000 yearly (and remember the coronavirus hasn’t been around a whole year, or even a whole flu season). The article also is not convinced that the 60,000 flu death statistic is a fair attempt at estimating reality as opposed to a made up number that signals how much the CDC wants us to worry about the flu, and the author suggests the CDC officially lower the flu death toll in order to signal that we want people to worry less about it compared to coronavirus (how many simulacrum levels are you on? You are like a little baby, watch this…)
Per-capita infections and deaths are only useful to form priors about how likely you are to be infected or dead. Until the number of people already infected is a substantial factor in how many more people are infected, a smaller population provides no substantial protection from further spread- when growth shifts to resemble the logistic curve exclusively, and no the exponential curve as well.
Even worse, looking at “the united states” is more or less just looking at “New York City”, so the per-capita denominator is simply as wrong as if “EU countries” or any other stupid aggregation was used. Frankly, aggregating all of New York City should be barely acceptable in considering global data; state and province-level aggregation should be the greatest done anywhere, and most metropolitan areas should be aggregated individually.
This seems clearly untrue? If nothing else, the fact that millions will have been infected and are hopefully now immune before we open things back up should both mean that hospitals are less likely to be overwhelmed and that the disease will spread more slowly since some are immune; probably fewer people end up being infected in the end because of the delay.
But that line of argument implies that we should have a level of restriction at which the hospitals are close to full but not overwhelmed, and in most of the world the actual infection level is well below that, implying that the restrictions are too severe.
They’re already falling apart though, which imo was kind of predictable. There is only so long a democratic government can maintain a strict lockdown before political pressure forces it to open back up, and we’re already getting there in some places.
If you assume that a 2-3 month strict lockdown followed by opening back up slowly is probably the limits of state capacity in most places, then it was probably correct to do it rather than to not do it, even if we never get a vaccine.
I don’t think remaining shut down for years was ever really on the table no matter if we wanted to or not.
Observationnal study in the Lancet with 96K patients.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext?utm_campaign=tlcoronavirus20&utm_source=twitter&utm_medium=social
Yeah; that really puts the ball in the park of those claiming it is indeed a net benefit when used with zinc, or used earlier. Note that this study is about hospital admission; so potentially a different beast than what is currently the most advocated quine therapy. However, the reason these studies were set up this way, is probably because that is the way people thought it ought to be used back then; and the fact that the theory has ‘evolved’ since is ofcourse a classic red flag.
Those championing quine+zinc+early intervention have had quite some time now to come up with more than anecdotes and in-vitro speculation now, and so far they havnt as far as I can tell. Until they do, this is plenty strong evidence that putting more quine in your system definitely isnt without potential downsides.
Hydroxychloroquine isn’t proposed as a treatment alone, but with zinc, which is supposed to do the heavy lifting. It’s being investigated. The article that proposed it as dead in the water made no mention of zinc. It’s like saying steering wheels are useless because it doesn’t help cars without wheels.
https://duckduckgo.com/?q=Hydroxychloroquine+zinc+covid+-trump&t=ffab&atb=v140-1&ia=news
So the question is, how do people print an article disproving hydroxychloroquine’s usefulness without even *mentioning* zinc? Do they not know? Why wouldn’t anybody who’s read a story about hydroxychloroquine, not know?
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html
CDC says something we’ve suspected for a while in these comment sections: shared surface is unlikely to be a big vector. We mostly need to worry about direct spread from person to person.
Scott, thanks for linking to our analysis of COVID donation opportunities on the EA Forum! I wanted to share that we updated our analysis this morning based on new developments and research over the past two weeks. Our current top charity recommendations are Fast Grants, COVID-END, and Open Source Medical Supplies. Much more at the link: https://forum.effectivealtruism.org/posts/opdMXibKjkoL69s96/prioritizing-covid-19-interventions-and-individual-donations
Re. the mystery of America’s low case fatality rate: wouldn’t much of this disparity be explained by how quickly the disease is still spreading there? To establish an accurate death rate everyone needs time to die. Since more of them are recent, fewer of the American cases have had the time to fully run their course, compared to most of the other countries graphed.
Testing more people probably correlates with testing earlier, too, so America’s having come through better on that front than it’s given credit for may have had the side effect of temporarily lowering its perceived CFR still further. Whereas in a country that can’t afford to test many people with sub-pneumonia symptoms the rate will initially seem much higher even if it’s actually identical.
Those linguistic findings are particularly interest in the light of this report about the relative lack of, well, air-expelling phonemes in Japanese.
Interestingly, southern dialects of German (such as most German spoken in Austria) don’t have aspirated stops (p,t,k). In English those sounds are typically aspirated (accompanied by a puff of breath). British English is worse in that regard than American.(compare British “Butter” to American “Buddr”.)
Hey everyone,
since it seems like we will be wearing masks for a while now, in one way or another, I would be willing to invest in some masks (ideally 5-7), which are a) reasonably pleasant to wear, b) washable/reusable and c) protect me and others reasonably well from Covid. I am aware that simple cotton masks, e.g. only offer limited protection for others and basically none for the wearer, but it seems to me right now that it is just not feasible to use proper (FFP2-grade or whatever) masks all the time for low-risk, non-care-worker people like myself. So I guess I look for something in the middle, where the trade-off is alright. Since there are thousands of offers on amazon etc., has someone made done some research which masks would be good, or what properties/certifications I should look for?
Thanks!
There was a study done and reported awhile back that showed that you could get much better protection from cotton or surgical masks by wearing them with, more-or-less. a piece of pantyhose cut into a loop and used to pull the mask tightly onto your face. The nylon doesn’t do anything for filtration, but it produces a much tighter fit. My guess is that this would also help with an N-95 mask in practice, since most of the time those are also hard to get a good seal on.
I haven’t seen anything offered for immediate sale that I’d trust in this application. Tracking down references, this seems like a pretty solid design for an improvised mask, with preliminary testing indicating a fit factor(*) of 67 (compared to maybe two for the more common sort of homemade mask). If the threat rises to the level where I feel a mask is warranted, I’ll be making some for myself.
Do note that, if you’re using a reusable mask, you’re adding the risk factor of transmission due to handling of the used mask. Particularly in a multi-person household where one person is doing everyone else’s laundry, and thus at greatly elevated risk. But even if it’s just you doing your own laundry, you’ll want to strictly adhere to a protocol of not touching the outside surface of the mask, with all the infectious material the mask spent the day protecting you from, without thoroughly washing your hands immediately afterwards.
* Roughly speaking, the ratio of particles blocked by the mask to those delivered by unmasked respiration/speaking/whatever. Due to nonlinearities in p(infection|viral load), actual protection will be lower in high-risk environments, but “less than a sixty-fold reduction” is probably still significant.
You can wash your hands after dumping all the laundry into the washer. Just don’t touch your face until it’s all loaded in.
The virus has limited lifetime on surfaces. Even if someone used a rag to clean up a giant pile of virus particles and tossed it in the laundry basket, 1 day later there will be less, and when I grab them out to put them into the washing machine I’ll get some fraction on my hands, which will end up spread out on other clothes and surfaces. But I’ll wash my hands with soap and water when I finish loading the machine, which both kills the virus and washes them away.
As JS above notes, with reusable mask, you should be very strict on how you handle it before reusing it. No touching when removing it, of course. With regards to washing, recommendations from medical professionals that I have received is that it should be washed after each use either in the washing machine on at least 60 degrees Celsius (washing machines in Europe have “programmes” with listed Celsius temperature, I am not sure how this is handled in the US), or boiled in the pot for 5 minutes, and after either of those, you should iron it.
@AlesZiegler (and @JohnSchilling)
> you should be very strict on how you handle it before reusing it
Could you try to put some numbers on this?
My complete guesses are that improvised masks are moderately effective (maybe a 75% reduction, reducing R0=~2 to R0=~.5) in preventing spread to others, but less effective at preventing the wearer from becoming infected (maybe reducing chance incidental airborne infection by 50%, realizing that not all infections are from airborne particles?).
Improper handling of a used mask shouldn’t reduce benefit to others, but likely reduces benefit to the wearer. I’m doubtful that improper mask handling would actually increase risk over non-usage, although I guess it could if air->mask->fingers->eyes is a dramatically more effective transmission route than air->inhaled. I’d further guess that the vast majority of viral particles are deactivated after drying on the mask, and thus the risk of re-infection from mask handling is actually much lower than than primary risk.
In my worst-case guess, maybe completely unsafe mask handling post-use reduces your net benefit by half, from 50% safer than no mask to 25% safer? And this reduction in safety could probably be completely nulled out by handwashing after mask handling rather than worrying about which parts of the mask you touch when taking it off.
If this is the case, I’d say that if you want to improve safety you’d be much better off reducing your risks in other ways (better PPE equipment, reducing exposure) rather than concentrating on “very strict” mask handling rules. Sure, you shouldn’t go around licking contaminated masks (although maybe ingestion isn’t a major transmission route) but proper handling of used masks doesn’t seem like a high priority worthy of emphasis.
Do you have better numbers than my complete guesses above? Can you justify your assertion that one should be “very strict on how you handle it before reusing it”, as opposed to all the other things you could be doing to reduce your risk profile?
Some numbers are easier to find than others, unfortunately. In particular, I haven’t been able to find anything quantitative about the risk of infection by handling of non-disposable PPE. It probably does factor in to the observation by MacIntyre et al that improvised cloth masks are associated with a net increase in disease transmission in health care settings, but that’s one poorly-controlled study that conflates multiple effects.
For wearer-protection, the half-dozen or so studies I’ve read are pretty consistent that the usual sort of improvised cloth mask when new and dry will result in a ~50% reduction in the number of small (1-10 micron, speaking/breathing size) particles inhaled. Since infection probability is necessarily sublinear with # particles inhaled, that’s going to give less than 50% protection but I have nothing quantitative on that. Maybe take the midpoint and call it a 25% reduction in risk for the wearer. I think one study showed that level of protection was little changed after three hours of wear, most didn’t consider long-term effects and none looked at a full day’s use.
For protecting others from the wearer, there’s more scatter in the data. I think I’ve got one study that shows no protection at all, two showing the same ~50% particle-count reduction as for inhalation, and others that don’t address the issue. Logically, it should be at least slightly lower because the pressure delta will act to open rather than close leak paths. So I’m guessing maybe 10-15% reduction in risk on that end.
Against these, we have the risk due to handling the used mask. That’s a concentrated risk for the wearer and whoever does the wearer’s laundry. But, as I said, short on quantitative data. We know the coronavirus can survive several days on porous organic surfaces, so basically everything the mask stops as an airborne-particle risk becomes a surface contact risk. Given the potentially high viral loads involved, and MacIntyre’s results, that surface contact risk may be sufficient to eliminate the gains due to reduced airborne transmission – instead of asymptomatic-carrier you going out and breathing on strangers at full strength, it’s maybe now you and your now-infected wife going out and breathing on strangers at 85% strength.
Also, I think there’s plenty of experience in the medical field generally that doctors being careless in their sterile procedure is a major risk factor, that you really do need to be disciplined about this. But, again, I can’t easily find numbers, because how do you even do a controlled study about that.
If you expect the mask to matter, don’t touch the active surface (straps OK) after you’ve put it on, until you’re ready to take it off and throw it in the washing machine. Then immediately wash your hands with soap and hot water, and when appropriate run the washing machine on the hot cycle. If you’re using intermediate storage for the used masks (e.g. a laundry hamper), that gets treated as a biohazard and you don’t touch anything inside it until you’re ready to dump it in the washing machine.
And again, if you really expect the mask to matter, don’t use the crappy one you bought on Etsy, make your own to the pattern I linked in the last post. Or an N95, if you can get it,
Larger droplets are probably at least as important as smaller ones in infection, and it seems almost inevitable that masks are better at stopping them.
Unfortunately, large droplets vs. improvised masks are another area where there’s almost no data, so I can’t address it quantitatively. Qualitatively, large droplets are mostly from coughing and sneezing. If that’s a big issue in your use case (e.g. you’re symptomatic and you’re going out to get tested), I don’t know how much good a cheap cloth mask will do but it’s almost certainly better than nothing and it’s probably better than the 15% for asymptomatic transmission. And it’s now even more important to be careful how that mask gets handled, obviously.
@John Schilling, we have one small study from Korea on viral load emitted by a mask-wearing COVID patient. Cotton masks significantly reduce viral load but don’t anywhere near eliminate it.
But as you say, we could use a whole lot more data there.
Scott: here is the model you are looking for
https://johnhcochrane.blogspot.com/2020/05/an-sir-model-with-behavior.html
Stylized of course, but Rt tends to 1 regardless of the assumption about R0 and for a wide range of potential behavioral feedbacks. I think there is potentially something important here despite the modeling simplicity.
I don’t understand all of this. It is clear that the lockdowns can be accepted for a few months at most, and cannot be repeated, without destroying completely the social fabric of any reasonable country, much worse than the effect of a completely uncontrolled epidemics of Covid-19. Let’s make a reasoning, unreasonably skewed in favor of lockdowns – i.e. assuming incredible efficacy of them, and neglecting almost all of their side effects.
Suppose we keep the restriction for “X years”. For X years all the population (P) will be unable to live a normal life, since they won’t be able to go to school, travel freely, have relationships and almost all the things that make someone’s life worth living. Let’s assume a scale factor: they are alive after all, so they don’t lose exactly “X years”. Let’s say, optimistically, that they are living at 50%, so they lose X*0.5 years each. Let’s assume also that the lockdown saves all people from death by Covid-19; let’s assume also the worst mortality, 3% of all population would die without lockdowns – so lockdowns would give them more years to live (let’s say an optimistic 10 years, since victims are mostly elderly), and assume also that these gained years are lived “fully”, not accounting for the restrictions. So:
– the general population loses P*X*0.5 years
– the potential victims gain on average P*0.03*10 years
The loss balances the gain when X*0.5=0.3, i.e. X=0.6 years, i.e. X=7.2 months. And this with extremely unreasonably generous assumptions in favor of the lockdowns.
The alternative, no lockdown and epidemics completely unchecked (in reality, even in absence of any directive, people would take some precautions) would be the 3% of the population, mostly elderly, dying in maybe a year. The normal state of things in countries with reasonably stable populations would be around 1% of the population dying each year for usual causes. 3% would be dramatic, we would see caravans of coffins as it happened in the most struck areas of Italy, but certainly it would not be a threat to the existence of anything.
Also, do you really think that an 80-year old would choose living the rest of his life locked up without seeing anyone except nurses, over living a normal life and risk an additional 20% chance of death by Covid-19 (20% is probably what he risks any year anyway)? In fact, elderly people were the least complying with the restrictions in Italy, which is completely understandable.
So I am now sure that lockdowns, except for a very short time, are an ideological choice not motivated by a real need or usefulness, supported mainly by the hypocrisy that all of us should accept to sacrifice our prosperity and freedom, regardless of the damage done, in order to save the lives of a minority, regardless of the size of the minority. This cannot be true.
Now, in Italy we are lifting some restrictions – we are almost at Sweden-restriction levels, since restaurants are open, people can move in their region, and we are also thinking of reopening gyms and swimming pools. Even if the epidemics curve were to rise again, there would be no more acceptance of new lockdowns, unless they are done for very small zones with localized outbreaks. Already for the first (and hopefully, only) round of lockdowns, the government had to suspend our constitutional rights (including elections), gained after years of civil war and 100000s victims in the 40s, institute government-based and scientist-backed hate campaigns against people going out for a stroll alone, which were only accepted because of the implied assumption that after a few weeks everything would have been over (and no, you cannot avoid a revolution by saying “but… I never said that I wouldn’t have oppressed you”). If they had to do for a second time, they would have to try imposing something like a North Korean dictatorship. Even if our constitutional court were to let this pass – but they have instituted a warning about the duration of the emergency – it would mean something like a civil war at best, and becoming North Korea at worst.
Another point I really don’t understand is the insane idea that we should alternate lockdowns and lifting of them for years, keeping an average R of 1. In Italy R was about 0.5 during the lockdown – mainly due to nursing homes spreading, unfortunately – and in Germany (with a less strict lockdown) it was 0.75, and in Sweden it seems R is very near to 1. If it is possible to have R~1 with restrictions which are acceptable to the population, then aim for a R slightly less than 1 with slightly more restrictions, and the epidemics will fade away in a few months at most. And with the reduction of cases, it is completely reasonable to expect being more able to do contact tracing and isolating, which would be even more efficient.
Then, if you think of keeping restrictions for years, you have also to account for the fact that population ages, so at the end of the lockdown people that have been protected will actually be more at risk due to their increased age. This is very significant if you try to compute it.
The grim reality is that our way of life is not threatened in the least by Covid-19, but it is threatened only by the unprecedented, and probably rationally unjustified, government responses to it.
Lockdowns were a good emergency response. And they probably make sense for regions with hotspots in the future, but much more tightly drawn than before. But their purpose should have been to buy time, in which to ramp up test production, hire contact tracers, and work out how to return to something close to normal life but with R_e much lower because, say, everyone’s wearing a mask when indoors around other people, there is ample hand sanitizer in every public place, and coming to work with a fever or a cough is about as socially acceptable as coming to work with no clothes on. Lockdowns can’t continue all that long, since they basically shut down a lot of what’s needed to keep society running and make lots of people miserable. We need something to replace them other than either “go give everyone you meet on the street a big wet kiss” or “stay in your home and never speak to anyone outside your family again.”
I hadnt thought to compare the coronavirus response to the iraq war yet. So the biggest blunder in cost effective medicine in my lifetime (or ever? cant think of anything else but not too sure of my history here), is only about as bad as the biggest foreign policy blunder in my lifetime. Thats reassuring in a way; except I think the long term costs of the corona response are yet to be tallied; and the iraq war was mostly an american phenomenon, whereas this unprecedented blatant disregard for the cost of QALY was a meme whos virality put that of corona to shame.
CDC: “The percentage leaving home measure is the inverse of the SafeGraph “completely home” metric, an indicator that a device has not moved throughout the day beyond approximately 150 m (492 ft) of its common nighttime location.”
By this measure, if I stay home all day but take a walk around the block each night at 10 pm, I will have moved beyond the 150m limit every single day. Such a measure hardly accounts for the degree to which I have limited by contacts with others.
Indeed, Apple’s Mobility Trends Reports page shows very different results. See, for example, the data from New Orleans.
https://www.apple.com/covid19/mobility
I am unconvinced by that defense of the EMH. It is unclear what the EMH means, and its versions tend to alternate, motte and bailey style, between a) making an interesting predictions that are empirically wrong, b) don’t making any falsifiable predictions, or b) making predictions that correct and quite banal.
Meadows has a bit of b) and c). His formulation of the EMH:
“You shouldn’t expect to beat the market without a unique edge, except by chance”.
This has a massive problem with defining what “a unique edge” is. I do not know whether I have “a unique edge” or not.
If it would be for example “You shouldn’t expect to beat the market without having an access to informations that cannot be find on the web, except by chance”, that would be an actionable prediction, but empirically wrong.
On coronavirus crisis, market has proven beatable if you paid close attention to publicly available knowledgeable sources about what is happening in China and Korea and if you had a basic understanding of epidemiology that we all picked up since then in few weeks. You did not even needed to read Chinese or Korean, since plenty of information was in English. That is a sort of edge that many people have in various domains, not some superhuman ability, out of reach for mere mortals.
Second part of his construction of the EMH is that unique edges tend to disappear some time after they are discovered as people tend to copy successful strategies which thus stop being unique. When it comes to moneymaking, we (or some of us) are learning creatures. That is correct but kind of trivial and not a discovery worthy of Nobel prize imho.
If the market is so beatable by anyone paying attention, how come so few have actually beaten it? Even the people touted here earlier about forseeing the severity of the outbreak and profiting off it got their later trades wrong, erasing the majority of the gains.
In fact, touting the death of the EMH by pointing to the success of an outlier or two is one of the most reliable ways to make yourself look foolish in the future. It’s all just reversion to the mean.
Or to sum it up, if you think it’s so easy, why aren’t you out there getting rich?
I am not claiming that market is beatable by “anyone paying attention”. If the EMH predicts only that “beating the market is hard”, well, I agree with that, but that is another trivial statement.
The market works because there are a bunch of people trying to beat the market. Some of them have to be succeeding, but (1) there’s not much evidence to say it’s the same people beating it each time, and (2) you are very unlikely to be that person.
So far from disagreeing with the EMH, you actually think it’s “trivial”?
I think that it is not well defined what the EMH means, and its formulations tend to alternate between “interesting but empirically wrong” and “correct but trivial”. None of them live to the hype of being some great insight about how society works.
It might seem trivial to you, but the number of people losing their shirts trying to play the markets suggests otherwise.
Strong disagree. The amount of people on Earth who have a sophisticated knowledge of both financial markets and epidemiology is low. Low enough to qualify as a “unique edge.” Dr. Fauci wasn’t able to predict the movements of the S&P, and Warren Buffet wasn’t able to predict the impact of COVID. I’m sure there’s someone out there who did both, but I haven’t heard of them yet…
And it’s both cheap and easy to fix.
Maybe not. Deficiencies in Vitamin D are correlated with a lot of bad things, but oral supplements often don’t fix that.
https://twitter.com/TrevorSutcliffe/status/1253190400136761345
The part that is missing from this equation is that some people will live X years longer than they would have otherwise. So, from certain perspective, the best case is that my mother will survive coronavirus, and the worst case is that she will only live X years longer than if we chose the “immunity to the young, death to the old” strategy instead.
By the way, is anyone doing statistics about coronavirus mortality vs whether people wear face masks?
I’m surprised no one has mentioned that last week Colorado announced it was modifying its covid-19 deaths with “deaths with covid-19” and the number of covid-19 deaths dropped 24%. I wasn’t all surprised based on what some states have been telling doctors as “guidance” on determining a covid-19 death including that a person doesn’t have to be tested for the virus. Doctors were never advised in the past on label flu deaths so why the sudden change. We also know that more federal dollars go to hospitals for covid-19 deaths than other respiratory deaths so the incentive is there to inflate the numbers.
I’ve heard of only three covid-19 deaths through friends and all were in March. Two 91 year old men in nursing homes who were dying from cancer and one wasn’t expected to live to January. The third was a 95 year old man who had several comorbidities.
The claim that the US has a low mortality is anything close to correct: in deaths per million inhabitants (and after removing the microstates San Marino and Andorra) it stands at 9th in the whole world. The countries with higher death rates (Belgium, Spain , Italy, UK ,France, Sweden, Netherlands, Ireland)
have an overall death rate of 505 per million (substantially higher than the America 283 per million) with a combined population of 284 million (vs. the American 331 million).
If you take the following countries in the list (Switzerland, Luxembourg, Ecuador, Canada, Portugal, Germany, Denmark), you get an overall death rate of only 126 /million for a combined population of 164 million .
If you further analyze the US rates by state, you will find that the most affected 23 states +DC (with a combined population of 156 million) have an average rate (509 per million) above that of the countries who lie above the US average. I am sure we could take those same data to argue something different (e.g. the other 27 states have only a 73/million death rate, which is just above Austria’s, wiedely regarded as a success story). My point is not to argue that the US is obviously worse than many others: the bad results are strongly due to the dismal performance of New York (1473/million) , New Jersey (1192/million) Connecticut (974/million) ,Massachusetts (862/million) (which may simply be freak outliers) but any analysis that states the 9th worse performer has “so low a death rate” seems to me to be (at least) less than enlightening.
I don’t know what statements you are reacting to. “Death rate” might mean “deaths per million of the population” or “deaths per million cases.” You are assuming the former, but those you criticize might be referring to the latter.
I am reacting to Scott’s statements in this post, where he is clearly speaking about raw deaths per million total population. I do not have a bone in this fight, but it pains me to see that Scott, who is usually attentive to data, reported the 9th worst performer in the world (according to his own chosen metric) as having “such a low death rate”.
PS: When looking at deaths / confirmed cases, the US is slightly better than the world average, but those are not the data that Scott chose to use. He made the correct call there, since those results are confounded by amount of testing and by the number of cases which have run their full course (to death or recovery), which are not as easily tracked as deaths. The true “ranking” will only be known by the end of the year, when we can compare excess deaths (vs. previous years) for the countries of interest.
The efficient markets hypothesis can be tricky to interpret. Obviously it’s not true that no one can ever make money. However, on average you will make what the market makes.
There is some discussion in the LW thread about some people who saw the initial drop ahead of time, predicting continued larger drops after the DJIA bottomed out on March 23, and losing money on the following trade. User Wei Dai still claims to be well up over the whole crisis, but it serves as a useful reminder. We had a discussion about EMH at our last in-person meetup on March 14, and I was asked about the “obvious” drop that had occurred that week. But the earliest date anyone could give me as having realized this fact was the previous Saturday, March 7. If you had tried to sell out as early as possible on the morning of March 9, you would have been fighting with all of the algorithmic fiber-optic hedge funds and would have done no better than the bulk of the market.
Moreover, the market didn’t go straight down. It went up and down several times; someone who predicted those spikes, or at least profited from them, could make even more money than only shorting the whole thing.
It’s also worth pointing out that the DJIA appears to have peaked on March 12, and there was a major drop starting on February 21. Nobody I know who claimed a possible EMH violation had the bright idea to short the market on February 12.
Which is a lot of words to say that consistently beating the market is a lot different from identifying one or two mistakes.
If you were to send investment advise to the January-1-2020-version-of-yourself, given what we know today and not trying to make any further predictions about tomorrow, what would you say in a few sentences?
Put all of your money into TECL immediately, buying as many shares as you can on leverage and sell all shares on 2/19/20. Put all that money into TZA on 2/19/20, use as much leverage as you can and sell 3/23/20. Buy TNA, again use leverage, and sell on 4/29.
TECL gains 38.1%.
TZA gains 201.4%.
TNA gains 121.6%.
If you use 50% leverage each time, each $100 invested at the start of the year becomes $3,111 on 4/29, less taxes and cost of margin. Using index funds means there is no risk the SEC will wonder if you were insider trading.
Sell slightly in-the-money S&P calls, expiry Mar/Apr. Use the proceeds to buy deep out-of-the money S&P puts expiry Mar/Apr.
“Is there a possibility where R0 is exactly 1? Seems unlikely – one is a pretty specific number. On the other hand, it’s been weirdly close to one in the US, and worldwide, for the past month or two. You could imagine an unfortunate control system, where every time the case count goes down, people stop worrying and go out and have fun, and every time the case count goes up, people freak out and stay indoors, and overall the new case count always hovers at the same rate. I’ve never heard of this happening, but this is a novel situation.”
On the contrary, this seems like by far the most plausible example of “straight lines on graphs drive reality” so far.
Could people who keep saying R0 to apparently mean R or Re (including, it appears, some eminent folks) please read the first paragraph of this: https://en.wikipedia.org/wiki/Basic_reproduction_number
In sum: R0 is the expected reproduction number of an outbreak in a population with no immunity. Re or just R is the name for the effective reproduction number – R0 of measles is 12-18, Re of measles in your neighbourhood following an outbreak at your kid’s school will hopefully fall below 1 pretty quickly.
See also this distressing prescient article from January 2019.
The only way Re would change without R0 changing is if people get vaccinated or infected. Changing social practices is actually a way to change R0, and not just Re (because there is no such things as “default social practices”).
I think R_0 also assumes no preventative measures taken. So nobody’s immune, nobody’s wearing masks who wasn’t before, nobody’s social-distancing, etc.
Depends on where you were trained, I think – I vaguely recall that some authorities do specify no preventative measures and others just no vaccination/medical intervention.
Interestingly regarding the role of loud voices in SARS-2 transmission, I learned today that German churches have reopened but have prohibited singing.
What if R0 is hovering around 1 because we have reached an equilibrium where the number of new cases is not anymore governed by the number of newly exposed people, but by the number of people who become susceptible (due to some unknown reason or just by chance)? In other words, what if in the beginning R0 was far greater than one because the number of exposed people grew exponentially, but now most people are constantly exposed to some degree, but only a small subset actually gets infected. Exposure might a necessary condition for getting infected, but not a sufficient one. This wouldn’t be herd immunity, because these other factors necessary for infection might fluctuate randomly. I suspect that other respiratory infections behave in a similar way, i.e. some people might temporarily not be susceptible for reasons other than an actual immune response caused by previous exposure. An initial phase of exponential growth would be followed by a plateau where exposure is not anymore the limiting factor for new infections.
I’m sure I’m not the first one to suggest this, but I haven’t seen any discussion of this possibility, and I wonder what people here think about this.
This is quite interesting, because serological tests in Europe (one survey on the entire population in Spain, and now one on blood donors in Milan) seem to imply not only that younger people are much less likely to develop symptoms when infected, but also that younger people are less likely to develop antibodies at all, with a gradual slope from 5 years old to 70 years old.
A tentative explanation was that students and children were shielded more by the school closures during the lockdown. But this contradicts other evidence.
That seems unlikely. The total number of infected people still seems to be pretty low – not many places have gotten more than 1% of the population infected at once, and I think most people are interacting with fewer than 100 people in the sort of ways that can result in transmission, so there should still be an exponential character, where the number of people exposed goes up as the number of people currently infected goes up. If there were general environmental exposure in most places at this point, then there should be lots of completely unexplained cases, and only a very small number of cases that come in clusters. But even in places that aren’t doing a lot of contact tracing, it seems that about half of cases come in clusters.
So, what institutions have comported themselves well during COVID? CDC and WHO obviously get failing grades.
My local church has done well, checking in with members and leaving care packages with crafts the kids can make for Mother’s Day. But COVID-response isn’t otherwise under their aegis.
Some local health authorities and hospitals in the Seattle and San Francisco areas seem to have done well (particularly with the early testing).
What do you think about India’s response to the virus?
They had lockdown, travel restriction, and screening way before anyone else. Still seems like nothing will work.
When you say they had screening, what does that mean? Were most people in most villages able to access this screening? Or was it only in the middle-class neighborhoods of the big cities? Or at airports?
I don’t mean to be too flippant… But does everyone ignore the ongoing Global War on (some) Terrorists ? Or is that wrapped up in the numbers for “9/11” ?
I get the impression that total deaths in school shootings in the US is smaller than the count of Americans who died in various operations in Afghanistan, Iraq, or elsewhere during the GWOT. If I’m wrong in this, I’m willing to be corrected. But most school shootings result in fewer than 50 fatalities [1], and the GWOT had resulted in many thousands of American deaths.
Is this a sign that the death count is currently at approximately Vietnam War plus Korean War, with a small fudge factor for deaths in school shootings?
Or is the GWOT not mentioned because it is still ongoing?
[1] The largest incident of mass-death at a school in America happened in 1927, and had 44 fatalities, plus 57 others injured. It was a bombing, not a shooting.
Total GWOT deaths is something like 8,000 people over 20 years (<5,000 in Iraq, <3,000 in Afghanistan). A lot of that is because we have vastly better medical care available than we used to, to be fair, but it's not like there's a huge number of deaths being ignored.
The United States has among the highest number of ICU beds per capita worldwide, and American intensive care is considered superb. I am not surprised in the least that the US has such low fatality rates. First-world East Asian and European countries typically have under a tenth (I think a twentieth, even) of the ICU beds per capita the USA has, and we all know that ventilators and ICU care are what keep fatality rates down.
I read most of the comments, so forgive me if I missed someone making similar points:
Like a few others, I find the lockdown to be not just wrong and useless, but actively harmful and thus offensive. As a teacher, I’m particularly horrified by closing the schools, which at best had a minimal effect on cases. To pretend this shutdown is anything more than a direct protection of the old and the sick and psychological protection of the wealthy at the expense of the young is simply to lie about what’s happening.
That said, and notwithstanding my fury at the shutdown, I’m living my best life. Teachers don’t usually get to timeshift, much less work from home. I hold office hours from 10:30 to 2 most days, with a few extra hours for working kids or a class that only meets once a week. I do a lot more review of school work than I normally would, and far more emailing. But I’m teaching and kids are learning, which reduces one of my huge fears. I think distance learning is a waste of time for ES and (unfortunately) MS, but at the high school level, even though the jackassed unions and districts eliminated every incentive to work, a lot of kids are working and learning. I’m also the initiator and adviser of a huge volunteer covid-19 related club activity at my school that alleviates some of my rage–the kids doing this wouldn’t get this resume value if there was no shutdown, so hey.
But the rest of the time, I’m just having a blast. I walk for coffee two times a day, for a total of 4 miles (the walk is a lot of the point). I go one of four or five hardware stores two or three times a week. I visit grocery stores practically every day (one of three in the area and I walk to those as well). I eat at my favorite sushi bar once a week. My hair guy comes to my house, because as the owner of his establishment he’s worried about getting caught. The others at his salon just see clients at his shop.
I drive to school a couple times a week and work with students on the volunteer activity. My garden looks fantastic. I visit friends, although not as much as we’d like, simply because most of them have a spouse who is more lawabiding than they are.
My brother is the manager of a very upscale grocery store (as in, Whole Foods is slumming it for his customers), and he doesn’t see any roots, if you follow, nor unkempt nails or beards. His son comes over once a week to visit. We have movie night. Sometimes we find a park and do archery stuff. Not that I know what I’m doing, but it’s fun to be in the air.
Anyway. On the first point, I’m boggled anyone does anything other than follow the laws that would get businesses in trouble if you didn’t. But then, I do realize there are upscale educated people who take this shit seriously. You see them in the media all the time.
Other issues:
1) I am terrified the schools won’t reopen because too many people think they’re guaranteed freedom from risk. The damage we are doing to our youth is incalculable.
2) Doesnt’ it seem likely that…I’m trying to think how to put this. I don’t think the risk of the virus varies by race. It does seem, however, that blacks and low-skilled immigrant populations are very badly hit. SImple non-compliance doesn’t explain the death rate, as so many people who get the virus don’t even know it. With African Americans, it seems possible that they are just more likely to be overweight, asthmatic, and so on. But even so, the differences are stark. After density and public transportation, I think that the higher percentage of blacks in NY is a big contributor to the different death rates there and in CA. And the map of immigrant population in the midwest correlates very nicely with covid clusters, while California’s meat processing plants have outbreaks but not nearly as severe, as they are not as likely to have refugee and new immigrant employees (odd, I know).
3) 100K deaths are a lot, but if you consider that it’s a new virus that specifically targets weak and vulnerable popualations, we’ve been lucky. This really isn’t that bad, and we should stop pretending that it’s dangerous to everyone and get on with our lives.
Thank you for sharing your perspective on this. Would you be willing to elaborate on what you expect the consequences of longer-term school closures to be?
In particular, what would you expect to be the key differences in outcomes between the following hypothetical students:
1. One who never experienced the shutdown and had a normal year.
2. One who goes back to school in fall of 2020.
3. One who goes back to school in fall of 2021.
4. One who ends up transitioning to home schooling as a result of the disruption and does not return to the formal education system until college.
(Disclosure: I have some negatively non-representative experiences with the formal education system that have given me some bad intuitions about it. In addition to being genuinely interested in your perspective, I hope hearing more from competent, ethical educators can help me correct those intuitions to better reflect broader reality.)
What do you mean by “outcomes”? Because learning outcomes are the least of my concerns. You also seem interested in one child, when it is massive groups of children that are my concern
So for example, I care not on the slightest about homeschooled kids, since the key determinant of that is the child, not the parent, in most cases. (That is, many a parent decided to homeschool and then returned their child in frustration to the school system.) Any child who wants to homeschool is atypical and one I’m uninterested in outcomes for.
The way to think of impact on kids is age and income level, as well as their attachment to school and the degree to which their parents can enforce behavior without that attachment.
As a group, regardless of income, the older students are, the worse they have been impacted by this shutdown, and the lower their income, the greater the potential damage. At the high end, high achieving students will have less ability to demonstrate their academic ability, and the fathead activists are going to be doing all they can to eliminate grades and test scores as a consideration permanently. RIght now, parents are too uncertain about their kids’ health, thanks to the asshole media (another group in favor of ending grades and test scores), so they aren’t even thinking about the damage this will do their students. By the time ES and MS kids get old enough to think about college, parents will have struck back.
There’s also a good shot that a lot of colleges are disappearing, and very little sign that state universities have the capacity and the funding to pick up the slack–and, given the push (already implemented in some states) to end the SAT for this year, the colleges will be demographics right down the line. It is entirely foreseeable that a bunch of low achieving kids with the correct demographics who did absolutely nothing for the entire time of the shutdown have had their profiles improved, ie guaranteed credit for all classes even if they spent the entire shutdown at a job or screwing around without doing a thing in school, which I say with no moral disapproval at all, simply annoyance that the kids who worked will have nothing to show for it. It is entirely foreseeable that rich kids will do better out of this than middle class kids, and white and Asian kids will be deeply and thoroughly screwed.
But then, the upside is poor kids are likely to be black and Hispanic or immigrant, and these kids have every chance of having their attachment to school, their willingness to go through the routine to get the (well-documented) benefit of a diploma decrease substantially. There are almost certainly kids who will end up in jail when they wouldn’t have otherwise because of this shutdown. And the chances of them being homeschooled snowflakes are exactly zero.
Immigrant kids with weak attachment to school, who showed up here in high school without any real formal education before that (a group I taught for 3 years) are almost certainly never coming back. Most of them came here to work anyway, so they’ll disappear at the age of 14, 15, 16.
Some people who think they’re being hardnosed will say eh, high school’s overrated. Best thing for kids who don’t want to be in school is work. Except it will often not be honest work, but crime. And, by the way, fuck anyone who says that when you consider this shutdown was done at the behest of cleanfreak shitheels who wanted little more than to enjoy the drama of a pandemic while bragging about their shutdown beard or pandemic roots.
On the plus side, if I try to be optimistic, this is almost certainly going to result in less immigration and a lot fewer illegal immigrants and refugees (even if Biden wins), and more interest in US manufacturing, which means that kids who aren’t terribly interested in college might have jobs to go to. But of all the things the idiots who brought this upon us want to ensure *doesn’t* happen, it’s that, so the forces of evil will be working against it.
Middle school kids are very badly hit because nothing matters in middle school. Everything gets wiped clean at high school, and they know it. Common Core has alredy had a dramatically negative impact on middle school, as the kids who are capable of doing the work do much better, while the kids who aren’t spend 2-3 years doing absolutely nothing, secure in the knowledge that they will be passed onto high school. But at least they had to get their asses out of bed and get to school. Now they’ll have spent months doing nothing and getting credit for it, thanks to the jackasses who guaranteed no child would be harmed by the shutdown–an outcome I support, but not by guaranteeing the same outcomes as kids who worked. There are other ways of ensuring they aren’t harmed. On the plus side, academically interested middle school kids, or those with parents who care, will have time for all the idiocy going on in college admissinons to be fixed.
Elementary school: if everyone had been honest and acknowledged that elementary school is impossible to achieve with remote learning, I wonder if the schools would ever have been closed. Every single bit of “schooling” these kids are being forced to endure is a waste of time. Fortunately, the kids forced into zoom conferences at this age have well-educated parents. At the low end, kids are going months and months without school, becoming less socialized to the idea and worse, many of them will prefer doing nothing.
Again, I don’t care about learning loss. I care about the millions of kids being shoved back into their homes without any structure, no interaction with their peers, and disconnected from their usual lives. I realize there are people out there foolish enough to confuse their own little school hell with the reality for millions, thinking “well I, a person who logs onto Slatestarcodex every day, would just love to be at home away from the mean horrible people who made my life miserable” but honest to god, I have no patience for those people, so if that’s anyone here like that, understand from a public policy standpoint, I don’t give a damn about your problems, that most kids who are bullied or bored were done so because of their own personal characteristics (again, both of these apply to me) and while it’s worth talking to your shrink about, they aren’t something that matters when considering the millions of upended lives.
And for what? Everything above would still be horrible if it was a disease that *actually endangered children*. It’d be horrible if the shutdown had actually achieved some meaningful number of saved lives compared to not shutting down.
NOne of that is true. It’s an appalling waste. Moreover, once closed, as I said, the burden on reopening may be absurd. I hope not.
Let’s assume we finish up this school year from home/Zoom, and next year we reopen normally (maybe with some extra disinfecting of schools or something, but a basically normal school year). My prediction is that two years later, there will not be a significant difference between this cohort of kids and previous years’ cohorts of kids. That is, I think the effect of this on kids’ actual knowledge will be basically zilch, after a year or two.
You know, just asserting that your beliefs are held by the other side and anyone who doesn’t admit it is lying turns out not to be very convincing to anyone who doesn’t start out agreeing with you.
As a parent who homeschooled and am interested in why other don’t, I’m curious about that. Could you expand on it?
Am I correct as interpreting your comments as implying that educating kids is not one of the main values of the school system? It sounds as though you see acculturation, broadly defined, as the important function, and the educational part mainly as a way of producing credentials to get a kid into college.
No, I think educating kids is valuable and an essential part of the school system. I think measuring what they learn, or thinking that two months out is some terrible loss that puts them behind is really dumb. THe last sentence of your comment is an incorrect statement; I don’t believe that at all.
I see school as a social ecosystem that comprises an enormous amount of kids’ lives and shutting it down cold is a bad idea that should only be done in extreme circumstances. Covid19 is not an extreme circumstance; rather, the media and educated elite said itw as. (and not for nothing, but the rest of their social and experiential lives are being simillarly crippled)
“As a parent who homeschooled and am interested in why other don’t, I’m curious about that. Could you expand on it?”
As to why most parents don’t: I think most parents see that ecosystem as considerably more valuable than the marginally extra information they can stuff in a kids’ head, which is why most parents don’t homeschool. Parents who homeschool tend to be people who see education as information pushed into a kid’s head and the more information pushed in, the smarter the kid is, the more advanced the kid is.
I know for a fact that’s nonsense, that education is a capacity, that acceleration won’t change what a kid is capable of learning. That parents who want to be sure their kids are challenged can do so without owning the entire education process (I raised an exceptionally bright kid).
But it doesn’t really matter, because, moving on to the point you wanted me to expand: ultimately, if the kid doesn’t like it the kid will make the parent miserable, and if the kid doesn’t care one way or the other then it doesn’ t matter, so long as the spouse footing the bill for the other spouse to stay home and school is able to continue. (Of course, in economic downturn, stay home spouse’s deliberate removal from the workplace often ends up being a really bad move, but them’s the breaks.)
The last parent I know of to do homeschooling for that purpose was James Mill. Are you generalizing from his case? If not, on what evidence?
The fundamental reason why I and my wife chose to home school — more precisely home unschool — our kids was that I went to a good private school, she went to a good suburban public school, and both of us were bored through most of our schooling experience. We thought we could do better for our children and, so far as I can tell, were correct.
Stuffing knowledge into children sounds much more like what conventional schools, public and private, attempt, mostly unsuccessfully, than what we did or what I have observed in other families who home school — admittedly a non-random sample — doing. Our children had no curriculum. We did our best to get them interested in things we thought interesting and to help them pursue those interests. They controlled their own time.
My guess is that the most common incentive to home school is that the parents would rather have their children acculturated in their culture than in the school culture. For religious home schoolers that may mean wanting to bring up their children in their religion — consider the Amish, who where practical run their own schools and routinely take their children out of school after seventh grade, as an example. For conservative or libertarian home schoolers, probably also for far left home schoolers, it’s not wanting to have their children indoctrinated in political views they believe are false. For socially conservative home schoolers, who might have almost any politics, it’s the equivalent for social views.
I have a not-very-informed suspicion that different kids will adapt to different levels to homeschooling. As far as I can tell, I’d have been fine–my whole life has been teaching myself new stuff based on my interests; my wife would have climbed the walls–she finds a classroom and the social interactions within really valuable to keep her motivated. Of my three kids, it seems to me that one does really well with remote-only education, one does okay, and one has a pretty hard time with it. Obviously this isn’t the same as normal homeschooling (where the kids would have a bunch of social stuff outside of school).
Are there numbers or even anecdotes on how many parents quit homeschooling after a year or two, because it’s not working well either for their kids or for them?
I agree with you that this is more likely than people realize.
So many politicians are out there saying “Things can’t re-open until we can guarantee they are safe.” The time at which you can guarantee nobody will get sick at school is literally never. This is an unachievable goal. Hopefully they’re just engaging in hyperbole and they don’t really mean it. But you never know…
What is your estimate for the percentage of students who are actively worse off because of the school environment?
Consider for a moment that there are people who do not adapt well to being in a room with 30-40 randomly hostile or indifferent other people. For those people, distance schooling, or leaving the school system entirely is a vast improvement.
From my response above:
I realize there are people out there foolish enough to confuse their own little school hell with the reality for millions, thinking “well I, a person who logs onto Slatestarcodex every day, would just love to be at home away from the mean horrible people who made my life miserable” but honest to god, I have no patience for those people, so if that’s anyone here like that, understand from a public policy standpoint, I don’t give a damn about your problems, that most kids who are bullied or bored experienced this because of their own personal characteristics (again, both of these apply to me) and while it’s worth talking to your shrink about, they aren’t something that matters when considering the millions of upended lives.
Exhibit A
Yeah, I already knew that teacher policy is that people who have a bad experience at school deserve it.
Causation is tricky. Most things have multiple causes.
If there are a substantial number of kids with personal characteristics that will cause them to be miserable at school but will not have similar consequences if they get their education out of school, isn’t that one important respect in which things you think have had horrible effects have had good effects?
Whereas I find your posts, and those of some other people with a background very different from mine, interesting precisely because you have had a different set of special pains than I have and, for that reason among others, can offer a different view of the world.
Well thank you for the kind words.
I am not normally righteously outraged. I’m cranky and annoying and sarcastic. But when I think about the utter havoc being wreaked on an entire generation of kids (and young adults) for what I see as utterly asinine economic destruction and someone says, in effect, “well, what percentage of kids do you think are better off at home because they were bullied?” making it All About Them, I see much more red than usual.
I do *not* think we *cause* our bullying or boredom. I do think our personal characteristics single us out for certain roles at various points in life. (although I also think there can be one offs). In no way am I saying that people who are bullied are responsible for their situation.
To pretend this shutdown is anything more than a direct protection of the old and the sick and psychological protection of the wealthy at the expense of the young is simply to lie about what’s happening
I don’t know who denies that other than a few hysterics. Most young people accept that trade-off though. I have asked young people why they aren’t welcoming the virus as a revolutionary opportunity to rid the world of boomers and the answer is generally that they don’t want their grandparents to die. Countries like Sweden, where people seem to be fairly cold and distant, apparently don’t mind sacrificing old people. In countries like Russia, where grandmothers keep the country running, a lock down is the only choice. The US is a fairly sentimental country on the whole. Of course the US and the West in general has the added problem that we have concentrated a lot of wealth and political power with the over-65s. The fact that Gen Z was already looking at a fairly bleak economy of gig jobs in a world where good jobs are disappearing to automation, off shoring or absorption by the tech monopolies may also be why so few young people are rebelling.
“I don’t know who denies that other than a few hysterics. ”
Then you don’t get out much. Much shrieking of “killing grandma”, much noble talk about how our kids might miss school, but they’d miss their grandparents more, and so on.
“Most young people accept that trade-off though. ”
Even if they did ( and oh, by the way, it ain’t boomers dying in huge numbers, although they are at a higher risk), and they don’t, they’re just responding to signals, it doesn’t matter. It’s not the right choice for society.
“Killing Grandma” is probably a fairly reasonable concern, certainly a month ago and based on the Italian experience. It is certainly a reasonable concern in countries like Austria or Russia where grandparents play a significant role in child raising.
When you talked about hysteria I thought you meant the crazy overreactions such as people who strip and wash their clothes after walking outside, disinfect their grocery store purchases, or decide that joggers running 10 feet away are going to make them sick.
Bethany Mandel went on Twitter and said “go ahead, call me a grandma killer” and lots of people decided to take her up on the offer.
Citation?
Closing schools is one of the few government interventions for which there are strong (negative) correlations to growth in COVID cases. I would put closing schools in the top 2 in terms of most effective measures to take if your goal is reduce growth of COVID cases. (NB: This might not be the correct thing to optimize for!)
Do you have a counter citation? What’s the research on this?
It was certainly expected to be a major contributor, and a reasonable plan at the start.
A week or two ago [1] I posted here a study here on SSC that suggested that children infecting adults was considered unlikely based on . . . based on contact tracing assessments, I think. [1] It’s possible that was wrong, of course.
One big confounder is that shutting down the schools indirectly shuts down a lot of workers because they no longer can let their kids roam free.
[1] God, it might be much longer, time has no meaning any more.
One big confounder here is that closing the schools also makes it a lot harder for both parents to go to work, so you get some additional decrease in workplace spread among adults. Another is that closing schools is a signal for a lot of other non-school social stuff to close down–my son’s Boy Scout troop stopped meeting and having in-person activities when the schools closed, for example, and that involves both kids and adults. Football games, school plays, band concerts, etc., are social events that include parents and grandparents as well as kids.
My only citation is my own work, which unfortunately I can’t share.
If it helps, I’m basing this on a sample of 25-country European countries. I used the intervention data from Oxford and Google mobility data.
My statement about which interventions worked is based on a linear mixed effects model estimating COVID case growth. Just about everything is correlated with everything, so model selection is a major challenge. Depending on how you go about it, you can get anything from “a few interventions have significant effects after you control for behavior” to “no interventions have significant effects once you control for behavior”. And it’s a legitimate question whether you should be controlling for behavior or use a two-stage model where government interventions influence behavior and you use behavioral measures exclusively to estimate changes in case growth. My approach has been “Use whatever works best empirically”, but YMMV.
Also, I’m not trying to assert any mechanistic reason that school closures would reduce case growth. It could be students as vectors, it could be parents having to modify their behaviors now that kids are at home, it could be something else entirely, or it could be a spurious correlation. (As noted above, everything is correlated with everything else.)
You’re wrong. There’s considerable doubt that closing schools had any impact, and even the studies that show some impact put it well down the list of factors. Plenty of cites, here’s just one.
School closure and management practices during coronavirus , report on same
Keep in mind too that the CDC never recommended closing schools and in fact advised against it until political pressure caused them to change recs. Notice their “clarification.
You’re citing a studies from early April that look at whether closing schools for other viruses mattered and an article about that study. They use no data from COVID-19 outside of pretty simple (and now weeks out of data) model. This was a fine thing to study, but it’s now two months out of date.
As for my claim (which you blithely dismiss), it’s an empirical claim based on actual data on COVID-19 cases and school closures across Europe. You can quibble with whether this correlation is indicative of causation or just an artifact, but my claim that such a correlation exists and is strong is not wrong.
If we’re going to speculate wildly about third-order downstream costs of lockdowns, we should also be speculating wildly about third order downstream BENEFITS of lockdowns, such as the increase in public health and school achievement caused by reduced air pollution, the unpredictable knock-on benefits from massive, global-scale, frenzied investment and research into RNA viruses, the efficiency gains from several hundred million people finding ways to get work done without leaving their homes, et cetera. The numbers are so huge and the range of variation so wide that outside of first-order effects we should really just assume the whole thing is a wash.
I think you’re right that there are lots of second and third order costs and benefits. But I’m not convinced that we should expect the whole thing to be a wash. If we’re looking at a system that has been tuned in various ways over years and decades, we should expect it to be in a better-than-average state along many dimensions. If we just randomly tweak it, we should expect those tweaks to mostly be more harmful than beneficial.
Of course, if we have a few months to optimizing our tweaked solution, we can probably use this tweaking as a discovery mode for breaking out of local optima and moving towards better ones, so maybe in the medium term it’s a wash or even beneficial, but in the short term we should probably expect it to be net negative.
It seems like the Swedish government is issuing social distancing recommendations, similar to other countries, and a lot of people and businesses are following them – they just mostly aren’t legally enforcable I think? But they are somewhat, their government is forcibly closing businesses that can’t/don’t social distance properly. So while they’re definitely not being as strict as most countries, they’re not exactly a strict “control group”.
Does anybody know about some papers employing interesting models to help them model the relationship between policies, public behaviour and the spread of COVID?
I’ve seen this (bunch of movement data from China is used to predict how many undercover cases are there) and also this (proposing a thinking framework that models the spread of the disease with something akin to Markov chains), which I bith liked.
I wouldn’t discount this explanation quite so quickly. The U.S. healthcare system is very expensive, but the statistics on outcomes can be sliced and diced a lot of different ways. Our survival rates for almost everything tend to be pretty good.
A few examples of this can be found in the summary of 5-year survival rates for various cancers by country (from the CDC). For those who don’t want to follow the link, it compares 5-year survival rates for 5 types of cancer across 7 countries (Canada, France, Germany, Italy, Japan, UK, and US). The US has the best survival rates for breast, colon, and prostate cancer. It has the second best survival rate (behind only Japan) for lung cancer. And it has the second worst survival rate (tied with Italy, ahead of only Japan) for childhood leukemia.
Two thoughts…
1. One of the principal functions of government is to “provide for the common defense,” and the coronavirus is a good proxy for nation-state biological warfare attack. So in that sense we can think of the coronavirus as a live-fire exercise that’s testing our ability to respond effectively to such an attack. In the U.S., the number of deaths isn’t really the issue…the point is that the government has failed miserably in executing this principal function.
2. When you talk about 100,000 dying, and comparing it to heart attacks or whatever, keep in mind that heart attacks are not contagious and multiplicative. (Neither are deaths due to medical errors, or any number of other causes of deaths that people are fond of throwing up for comparison.) If heart attacks were contagious and multiplicative, would it change our thoughts about their acceptability?
Being Swiss, I can tell you that there is a vast difference in term of discipline between the latin part of the country and the germanic part. As much as there is a vast difference between the latin part of Europe and the germanic part. People are just more careful not to hurt society as a whole in Germany and the northern countries of EU where in Italy they protect their family first. I guess these are just cultural traits. There are many books on cultural differences, it would be interesting to do some correlation with the spread of the virus.
Also Italian and French constantly touch themselves and others. They kiss on the cheek to say hello, even men. They gesticulate and stand closer. They are more vocal, constantly debating and arguing. Also, they speak different languages, some languages are just more explosive in term of their phonetic.
Greece is much more similar to Italy than to Germany in this regard, thought, and they have only a few cases.
One hypothesis is that nicotine is protective but smoking still harms your lungs, so smokers are less likely to get it but more likely to die if they do.
A possible explanation for the data from Swiss cantons: The disease is spread by vowels. Consonants have a protective effect.
Thanks for bringing up human contact. I’m embarrassed to talk about it when the stakes are lives and livelihoods, but it’s freaking me out. I live alone, I’m not in a relationship, and my friends aren’t physically affectionate that often. But the times that they have been are pretty much 100% of my positive emotional experiences.
In my experience, I’ve seen that friends who live alone and friends who live with children are in many ways equally devastated by the current situation, but in very different ways. Those of us that live with partners and without kids are generally doing fine, and have to remember to figure out ways to reach out to our friends in these other groups. Pester your other friends who live without kids to do Zoom happy hours or Netflix parties or whatever.
The link already mentions that we need to control for demography. Prisoners tend younger and maler [sic]. They are also more compliant with orders than the general population.
An interesting comparison might be the dormitories for foreign workers in Singapore. They also tend younger and maler on average, though probably healthier , since you need to be at least somewhat fit to work in eg construction but there’s no such fitness requirement for being in prison. Also mentally healthier, for obvious reasons.
Normally workers are free to leave the crammed dorms and hang out in anywhere in Singapore, but with the recent lockdowns there wasn’t much of that.
The vast majority of Singapore’s recent tenfold increase in cases happened in the dorms. Luckily, many cases were asymptotic or mild. No deaths and no one even needed to go to ICU.
So very similar to what was reported about prisons.
Younger makes them less likely to die from the disease, maler makes them more likely to.
I find it hard to believe that unemployment has spiked so high, but this hasn’t resulted in people staying home from work. So I followed the link, and they’re measuring “staying home” like so:
This is a pretty strict requirement! I’m working from home but I’m taking a walk every day on my lunch break – that would not qualify as “staying at home” by their metric. So this may simply be telling us that people who are social distancing are not becoming complete hermits.
Been reading a lot of Kipling recently.
Did you know he has a weird poem on Epidemiology?
“The Spies March” in which he portrays (I think) scientists and specifically epidemiologists as spies in the war between mankind and disease. The tone of the poem is interesting because he gives humanity a desperate but slightly contemptuous voice, exactly the way you’d address a spy.
A lesser-known kipling but it has some evocative bits. I’m taken by the fact that many of the questions that Kipling’s “spies” wrestle with are STILL hard to solve in 2020.
*Does he feint or strike in force?
Will he charge or ambuscade?
What is it checks his course?
Is he beaten or only delayed?
How long will the lull endure?
Is he retreating? Why?
Crawl to his camp and make sure —
That is the work for a spy!*
https://www.poetryloverspage.com/poets/kipling/spies_march.html
I did not know that, which is surprising as I’m an epidemiologist who reads a lot of Kipling. Thanks for sharing!
So, for a less depressing topic, what’s your favorite Kipling poem?
Mine is probably “The Mary Gloster,” although I’m also fond of “The Hymn of Breaking Strain” and many others.
It’s a toss-up between “Hymn of Breaking Strain” and “Sons of Martha”, depending on my mood. But as you say, the good stuff is too numerous to count.
That’s a hard question. Possibly “Poseidon’s Law”, but “Recessional” wears its own weightiness so well I may have to choose it.
“The Mary Gloster” is the best Browning monolog I know, better than the ones Browning wrote.
One of the things I like about “Hymn to Breaking Strain” is that it is modern poetry in a sense in which most modern poetry isn’t. Also true of something like Cummings’ “Electrons deify a razor blade/Into a mountain range.” Perhaps also “She being brand new.”
Are there other good examples of poetry where the poetic material depends on things that didn’t exist in the century before the poem was written?
As I predicted a while ago, Brazil is fast on its track toward “full-blown humanitarian disaster”. Our president is STILL doubling down on hydroxycholoroquine and his followers are in full science-denial mode. Meanwhile, we just had the largest amount of deaths in a single day yet (1.200) and the spread seems to be actually accelerating.
The media seems to be catching on to how absurd the situation is getting, and at this point I think I can only hope that the population eventually catches on to the ridiculous levels of epidemic mismanagement going on.
But, for what it’s worth, I think my home country might be done for. We’re in for a terrible decade – or couple of decades.
Some reports have surfaced online saying a Mesa man who died in March after ingesting a chemical similar to that of a drug discussed amid the coronavirus pandemic is under investigation as a homicide.
Detective Jason Flam with Mesa Police Department told ABC15 Wednesday morning that those reports are not accurate.
“It is normal protocol at the Mesa Police Department for all death cases (other than obvious natural causes) to be investigated,” Detective Flam said. “All death cases are assigned to a homicide detective for their review as a matter of protocol. Please do not confuse this fact with what is currently being reported that this case is now a homicide investigation.”
and…
“This investigation is NOT being treated as a homicide,” Mesa police said. “The death of Gary… has not been ruled a homicide at this time.”
https://www.abc15.com/news/region-southeast-valley/mesa/pd-reports-that-mesa-chloroquine-phosphate-death-is-homicide-investigation-are-not-true
Seems the National Review article is mistaken.
To add to the confusion surrounding Coronavirus outcomes, the testing rate of the province of British Columbia is half the overall Canadian testing rate, but Coronavirus is well-contained there. The provincial government did not issue a lockdown order. Why should they have better outcomes than places with higher testing and more stringent orders?
Some random ideas: People from Quebec or Ottowa are more likely to go to New York then people in Vancouver are to go to Seattle; Seattle has had less spread then New York so with the same amount of cross-pollination you end up with fewer cases in Vancouver then in Toronto or Montreal; Vancouver (well, I’m thinking mostly of Richmond when I propose this to be honest) is more culturally Asian with respect to disease and masks work.
How can we tell whether excess mortality is due to COVID-19, vs very sick people avoiding emergency departments and dying at home?
Here’s a preproof which finds treatments for a certain category of cardiac events in the US have dropped by 38%, here’s an article that says hospitals in Victoria, Australia have seen 50% fewer new cancer patients and 30% fewer cardiac emergencies. This is particularly important in a country like Australia where only 100 people are known to have died of COVID-19 so far, vs roughly 17000 cardiovascular deaths in 2018.
Italians have released daily mortality data down to (almost) every commune. You want the “analytical dataset” from that page. Then you can compare excess mortality in 2020 compared to previous years in regions/provinces/communes where there’s lots of COVID-19 vs. regions where there’s hardly any (for provinces you can get the COVID-19 data off wikipedia). The lockdown measures differ somewhat, but Italy does have a nationwide lockdown. I think you’ll find that if you focus on no-COVID places, there’ll be very little if any excess mortality.
I read it was generally negative excess mortality, like -10%.
So when folks are counting all the QALYs, do the government interventions get credit for saving those lives in addition to the COVID-related things? 🙂
I was chatting recently with some folks at one of the ambulance services I volunteer with. Not only are calls for critical things like heart attacks and strokes down, but at-home mortality is also down. We aren’t seeing increasing calls for people dead at home. We can’t really explain it.
The best guess I have is that some of these things are less fatal than most people think, but have significant morbidity. Eg. someone has a heart attack at home, doesn’t get treatment and has permanent but non-fatal heart damage. So they can no longer do anything more strenuous than walk from the bed to the couch, but are still technically alive.
IDK. This whole thing is weird.
It might also be that many people that are prone to these sorts of acute things are being extra careful not to engage in activities that might trigger them. It would be surprising if they’re being much more careful than drivers, who seem to be killing at a comparable rate, given the amount of driving they’re doing. But not completely out of the question.
I remember under the March 27 Coronalinks post steve3920 wondered if “Maybe some spoken languages create more droplets and aerosols than others, causing country-to-country differences. Any linguists here? And/or maybe some cultures have closer face-to-face talking than others.”. I decided I was too biased to evaluate that idea, because if it turned out to be the case, Hideo Kojima’s vocal cord parasites would’ve proved incredibly prophetic.
This hypothesis was written up back in 2003: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)13874-3/fulltext?code=lancet-site
I’ve found a couple other studies that looked at some more details. One that includes several languages (though I don’t have a sense of the results) is here: https://www.nature.com/articles/s41598-019-38808-z
One that finds differences among phonemes within English is here: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227699
Ultimately I think countries like New Zealand are going to show that nearly eliminating the virus and test/trace/isolating allows for a stronger economic future then countries that waffled in the early days and didn’t invest everyone in the trace/isolation phase either. Even if we decide to 100% prioritize the economy this is probably the way to do that.
I think that New Zealand especially is going to show that placing too high a priority on eliminating the virus at all costs, will come at a ruinous cost and will cripple their economy for years to come. And we’ve discussed this here before. But, sure, go ahead and explain your version.
New Zealand had a quickly-implemented, very hard, mostly-honored, lockdown and has basically eliminated covid-19; but the lockdown was roughly six weeks long and the internal economy is fairly open now (albeit with new guidelines on social distancing.) Other places with weaker lockdowns have been looking at multiple months of a slow simmer. The economic costs of A vs B are unclear. I think that all else being equal the New Zealand policy is likely a win, but who really knows. IMHO New Zealand’s internal economy, now basically sans-covid-19, would bounce back very quickly – if not for subject of the next paragraph. Go to a supermarket in New Zealand today and there are no shortages; including sanitizer, masks (95 or surgical you choose) [yes, supermarkets], any meat, flour, etc.
HOWEVER, in addition the lockdown New Zealand also closed its borders: incoming travelers (citizens or not) face 14 day quarantines. This single policy probably deserves a lot of the credit for the near elimination, and in retrospect the lockdown itself could perhaps have been lesser given it. But so much of New Zealand’s economy is based on overseas tourists (and other overseas travel) this will be devastating. The economic damage will last years, perhaps decades.
IMO New Zealand will suffer horribly, but not because of it’s ‘at all costs’ policy, but because of one specific cost incurred and which will likely continue for at least the next year. It still might be worth it at the end. Or not. But it’s this ONE cost that will have years-long consequences.
In fairness, the lockdown+eliminate COVID-19 strategy only works if New Zealand also closes the borders (or implements something like a mandatory 14-day quarantine, which has nearly the same effect).
The strategy of wiping out infections entirely requires you to drastically limit movement between your area and regions that continue to have endemic infections. That’s an inherent cost of that approach, not an oddity of what New Zealand is doing.
I also expect that New Zealand’s approach will probably fare worse economically than alternatives. Some countries could reasonably withstand dramatically decreasing international travel — although it would still hurt — but I don’t think New Zealand is one of them. It’s also extremely hard for them to course correct, since even after the rest of the world muddles their way close to herd immunity, New Zealand will still have to keep their borders closed or else even a small number of infections in NZ could grow exponentially and undo all of their previous successes.
Of course, if we get an effective vaccine relatively soon, then NZs approach might end up turning out okay.
Or they could figure out an efficient way to test incoming folks (perhaps before they take off so the results are in by the time they land?) so they don’t have to do a 14-day quarantine. Doing it early, when there’s more uncertainty about testing and you don’t have a process in place, makes sense, but there’s no reason that has to be the long-term solution.
Also, IDK how many people would’ve been flying to NZ these past two months (or in the next two for that matter) regardless.
That’s roughly what Czechia is trying to do now: you can enter without a quarantine if you have a recent test (or you can get a test and if it is negative you can end quarantine immediately). Not sure how well this will work out, especially because you have to pay for the test yourself and the cost is around $150, or around 1/10th average monthly salary pre-tax. This makes travel quite expensive.
Also you can’t enter at all unless you have business/close relatives/few other things to do here, but a more relaxed approach is being negotiated and will likely happen soon.
To-may-to, to-mah-to. If you don’t have an “at all costs” policy, it’s usually not too hard to recognize that one particular cost is likely to be ruinously expensive and avoid or mitigate it. It’s having the “at all costs” policy that shuts down rational thought and makes you pay full price for even the most expensive parts.
And, that’s how “at all costs” policies do their damage – not by raising every price uniformly to a collectively intolerable level, but by allowing a few ruinously expensive costs to slip in among the modest ones.
How do you avoid or mitigate a ‘closed borders’ policy if that’s doing most of the work for you?
Honestly, I have to wonder if I’m completely missing your point. New Zealand has incurred costs that otherwise seem to be collectively tolerable (and now with these mostly behind them, one can say: tolerat*ed*), but with one specific policy will be hugely costly long term that can’t be relaxed soon – but everyone is painfully aware of and hasn’t been ‘slipped in’. Are you suggesting that because of the (now nearly-over) lockdown, people and the government have somehow not “fully recognized” this one cataclysmic cost and therefore done less than they could – to the best of their knowledge – to mitigate it, because it’s somehow just ‘slipped in’? It’s hard to accuse someone who is never ever wrong of being, can I faintly hint at it, wrong, but are you sure of that?
One obvious approach, which I believe has been discussed here in the past, is to replace the two-week quarantine requirement with say three days and two negative tests for travelers from low-risk regions. That won’t be perfect, but no ‘closed border’ is perfectly impermeable and this would almost certainly reduce the problem to one where ordinary public-health measures would contain the occasional leaks. And it would be much more compatible with people visiting New Zealand for the tourism and business dealings that their economy depends on.
It is hard for me to assess the understanding of New Zealand’s government and people on this issue; we have no representatives of the former and only highly atypical representatives of the latter here. But the media coverage out of NZ has been conspicuously short on discussion of the economic consequences of closed borders on a trade- and tourism-dependent economy, so I have to conclude that either A: this really has slipped by a people and a government too narrowly focused on short-term public health, or B: they’ve knowingly decided to court economic catastrophe and to not talk about it in public.
Everyone within NZ is well aware that tourism is screwed, and hospitality as well. There is huge pressure to get NZ to open the border with Australia. There are campaigns to try and encourage New Zealanders to travel domestically and ‘back your backyard.’ There’s all the news articles for all the layoffs at Air New Zealand and big tourism companies. And the prime minister in her live streams talks about how tourism is going to struggle*, and people are arguing that tourism businesses need more support vs. why support something that is screwed anyway.
So there’s complete awareness inside NZ that tourism businesses are screwed here, and that they are 10% of GDP, even if there is still majority support for the way the response was handled here. (there is a lot of dissent on that point though). My understanding is that in the US, NZ is seen in the media as unscathed thanks to our flawless response. Nobody here is any under illusions like that.
*there was a minor political dust-up when a labour minister said in an interview that maybe these tourism businesses weren’t in very good shape anyway if they didn’t have enough cash to weather this situation. The PM had to apologize for the statements and disown them
Yeah, most of our media coverage from New Zealand is about how awesomely they defeated the coronavirus by doing everything right, e.g. this. Fifield is a New Zealander reporting from New Zealand, but at least as far as the Washington Post is concerned nothing about trade and tourism, the prospects for reopening the border, or the consequences of not doing so, is even worth mentioning.
Thanks for a different view from the ground in NZ.
The facts “on the ground” in New Zealand is that the domestic economy has largely opened up (including gyms, restaurants, etc), with a few very mild restrictions that many people/busineses would probably do tend to to anyway.
The travel from overseas/quarantine restriction is the ONE thing that has not been eased at all, and there is no timetable for doing so (other than the vague-ish hope of easing, within in the next few months, travel between other mostly-covid-free countries like Australia and Taiwan).
The government (and, I suspect, a lot of the populace) is totally aware and aghast at the cost of the travel restrictions. But this expensive policy did no more slip in due to a blanket ‘at all costs’ philosophy than it it slipping out now, now that basically other costs are being relaxed to nothingness, if not waived entirely. Wouldn’t your ‘slipped in’ hypothesis also tend to predict ‘slipped out’?
Suppose there were no restrictions on foreign visitors. Wouldn’t the tourist industry be hit almost as hard, just because people are not traveling? Even if New Zealand is safe, getting there isn’t.
You might have some travel from people who wanted to spend the next six months or a year in NZ because it was Covid free, but a two week quarantine wouldn’t block those people.
The question doesn’t really make sense because if NZ opened its borders in a way in which getting on a plane was a risk, NZ would soon be full of infections anyway. So that isn’t going to happen.
The first border opening will be with Australia once the risk is low enough and things are set up, and getting on a plane then, the risk will be effectively zero. In normal times, 13% of Aussies taking tourist trips around the world go to NZ. If NZ is their only option it will be 100%, so 8x higher. Of all international visitor spend in NZ, 24% is from Australians. So an increase of 8x Aussies would mean double the normal total international tourist spend. Less Aussies will travel in these times, but it is still significant.
There is a world of difference between
20% of normal revenue with a hopeful future
0% of revenue with no idea when we will get revenue
We can make staff redundant, go onto interest only financing, negotiate rent decreases, etc to keep ourselves alive for a long time on 20% revenue. 0% is a lot harder, especially when we have no idea when we will see business pick up. It means lots of wasted capital and delayed reallocation of people and resources while we wait and see.
Is this the right comparison? 100,000 deaths isn’t the cost of taking no action on coronavirus. 100,000 is goal state of the resources you invested against the virus. If the sun were going to explode and destroy the Earth, the planet might spend 500 trillion dollars on a spaceship to fix the sun. This project succeeds but results instead in a small solar flare that causes 100,000 deaths instead, but you wouldn’t argue whether spending 500 trillion was really worth saving 15% of heart attack victims.
Very good point. And I would also add the following somewhat related points.
100,000 deaths is 15% of US deaths from heart attack in a year, whereas COVID19 has killed 100,000 people in 2 months. So this is 90% of how many people die of heart attacks in two months. I think a 90% increase in heart attacks, or a new condition killing old people at 90% the rate of heart attacks, would indeed be a concern for the public.
And this is all not even counting the number of people who are indirectly dying due to COVID. For instance, people who have heart attacks or other health emergencies but are afraid to go to the hospital and catch COVID and so die.
Heh. A week ago, when Spiegelhalter divided Europe into countries doing well and badly, I couldn’t help noticing that his good countries were mostly speakers of Germanic languages, and his bad countries were mostly speakers of Romance languages. The exceptions were Portugal in the ‘good’ column, and Britain in the ‘bad’ (English being a double creole of Germanic, Norman (itself a Norse/French combination) and French).
So has anyone tried splitting the Belgium data into Flanders and Wallonia?
Romania, Sweden and Netherlands seem like other exceptions.
Greece is culturally very similar to Romance language countries, and Greek language phonetics (if that plays a role) is also closer to Spanish/Italian than to Germanic languages. Yet they are doing very well, even better than Nordic countries.
This is of course a hypothesis with a bunch of geographic confounds. I think Romania has patterned with the west-Slavic countries rather than with the Romance countries, while Hungary and Finland are somewhat different, which may or may not help the theory.
What’s up with the section headings? Has the stock of Roman numerals run out, or is the cargo ship quarantined off the Islets of Langerhans?
Does anybody have good arguments why it is not very likely that the virus originated in the WIV?
The claims read that the WIV:
1) Did gain-of-function experiments in recent years (published in the appropriate journals) on Corona viruses where they pasted a new spike protein into a known bat virus to enable it to infect human cells.
2) Discovered virus1 and virus2 in the last decade (also published these discoveries in the appropriate journals)
3) SARS-CoV-2 is mostly identical to virus1, except that the spike protein is very similar to virus2. Also it has an additional sequence (Furin cleavage site) that is known to make viruses more infectious to human cells. This sequence is neither part of virus1 nor virus2 nor of other close relatives of SARS-CoV-2.
If these three points are correct it seems extremely likely that the lab-origin-theory is correct. Of course it could also be the case that the article I read about it is full of made-up stuff. Does anybody have any insights into the pros and cons?
Trevor Bedford has a twitter thread addressing this (although I don’t think he’s dealing specifically with a gain-of-function scenario as opposed to generic lab escape): https://twitter.com/trvrb/status/1230634136102064128?s=20
In addition, our priors should be weighted heavily towards a zoonotic origin. Almost all novel diseases have zoonotic origins. Indeed, the Wuhan area/Chinese wet markets have long been of concern specifically because they are ideal breeding grounds for viruses to make the jump from humans to animals.
Furthermore, although I’m by no means an expert on this stuff, I don’t think your point 3 effectively distinguishes between a lab and zoonotic origin. Virtually by definition, a novel infectious agent as efficacious as SARS-CoV-2 is going to have undergone some sort of evolutionary adaptation sufficient to enable it to jump to & thrive in the human population. So you would expect to see these kinds of adaptations regardless of whether the source is zoonotic or lab. After all, the whole goal of gain-of-function research is to investigate how evolutionary adaptions in the wild can lead to new agents with new functions.
At the end of the day, we’re not going to have a definitive answer to this question (if ever) until the viral geneticists have had enough time to beat on the problem. But given the current state of the evidence, it seems like we are firmly in hear-hoofbeats-think-horses-not-zebras territory.
That twitter thread goes into the direction I had in mind. If one can rule out that the differences between these two known WIV-viruses and SARS-CoV-2 could have happened after a putative gain-of-function experiment, the case gets much weaker.
Would be interesting for an expert to compare the existing differences, the evolution of SARS-CoV-2 during the epidemic and what one would expect to see after passing such a virus in human cell cultures or ferrets.
Almost all novel diseases have a zoonotic origin because the ability to easily create new viruses is very new. And there is a history of dangerous pathogens escaping from labs, it’s not exactly a rare occurrence.
The closest study I’ve seen to that is here, and it tends to come down firmly on the side of “natural evolution/mutation”.
The Proximal Origins of SARS-CoV-2
It’s worth noting that I came across this study precisely because it was referenced off-hand in a video a friend linked me in which an Irish politician and her Youtuber interviewer were using it to try argue the exact OPPOSITE of what the paper found (never trust someone else’s report of what a study says, ladies and gents, example # 8,373,641).
Good counterargument is that you should not assume that those points are correct, and instead you should assume that whatever article you read on it is full of made-up or at least misleading stuff.
I prefer to deal less in assumptions and more in facts. My question here is part of fact-checking. The lazy part, but still.
But it is hard to factcheck an article you did not linked too. Now I see that you did that below.
Regardless, I lack relevant domain expertise to factcheck it per se, but there are reasons why I have a strong prior on virus coming from unsanitary Chinese food markets instead of a lab.
We know that those markets already produced broadly similar virus (first SARS epidemic), and their operation have not significantly changed, making them an obvious source of risk.
In contrast there was never any epidemic coming from a laboratory accident, as far as I know, despite laboratories dealing with dangerous viruses all over the world for decades; of course such thing might theoretically happen, but when you have an epidemic coming from a Chinese city with both unsanitary food market and bioresearch facility, my prior is firmly on food market origin, unless multiple credible authorities in virology say otherwise. Especially since there is a preexisting sci-fi trope of viruses escaping from laboratories, which I think neatly explains why lab origin theory emerged so quickly.
Do you have a link to the relevant article?
This one.
For what its worth, I currently have license to force an intern to do a lot of regression analyses on Covid-19 data and our conclusion so far is that most of the variation in death rate (between countries and US States for which we can find the data) is due to
A) Undersampling, i.e. testing
B) State of the epidemic (lag of death means death rate rises over time all else being equal)
C) Age of the population
These three factors explain something like 70-80% of the variation and there is bound to be a lot of noise.
Also, Italy is a significant negative outlier, so probably health system collapse is not great.
Caveat is that we looked only at developed countries. Hard to know what is happening in countries that can’t keep on top of testing.
Did you look at comorbidities at all? I’d be interested to see how much work is being done by age and how much by just being generally sicker, if you could set it up so as to avoid multicollinearity problems. Or something like a test-case-fatality rate between areas with similar testing availability and thresholds, if that’s in the data.
We did look at obesity but couldn’t find an effect.
Again the fact that Musk can significantly influence local and state governments (disobeying emergency pandemic orders!) is strong evidence against the theory that billionaires can’t exert enormous influence because their resources are a small fraction of total government resources.
Now he is going to go bleed Texas dry by making them finance his factory, which will never offer any kind of payback to Texas, just as he did in Buffalo and China.
And when Musk tried to defy the orders originally and was forced to shut down did you post ‘boy, I thought billionaires could do anything, guess this is a data point against that’.
Huh? No one has limitless influence, the point is that they have a lot more than many are claiming.
And Musk did defy the order at first until he relented, he may have succeeded if he really pressed the issue but he decided not to.
OTOH if Musk was just a random dude who ran a barbershop that didn’t get shut down, you never would have heard about it.
Is Musk really exerting undue influence, or is he just the highest profile person to “call Alameda’s bluff”?
Unless every business not run by a billionaire is being forcibly shutdown, the latter is a real possibility.
Does anyone have excess mortality data that’s broken down by age?
I don’t think anybody has it live, not in any kind of reliable or validated way.
Historical data, CDC has you set.
Euromomo has number of deaths by age for western Europe and excess mortality by age and by country. But the fine-grained data is confusing because it isn’t number of bodies, but transformed into z-scores. It has up-to-the-minute data, but the most recent data isn’t reliable.
I don’t see how that is relevant. It’s just N=20 ! We already know that fewer than 5% of people get reinfected. We test for antibodies, so of course we know that people produce antibodies. There have been a lot more than 20 cases of people donating antibodies and curing someone already infected.
The worry is that people getting reinfected after 30 days are the tip of the iceberg. If they produced antibodies, but only for a short time, the typical immunity might be only 3 months or 6 months.
Every infection that still exists and isn’t currently in an epidemic has R0 exactly 1. In the long run, a balance between herd immunity and new births (or temporary immunity) provides negative feedback to keep it at 1. But if it has been at 1 after only a few of months, that is mysterious.
Technically that’s R_effective rather than R_0. R_effective tends towards 1 as the infection rate tracks upwards or downwards whenever it is below or above 1.
I don’t think that’s correct; if it were the total number of cases of all infectious illnesses would never vary across time. R0 estimates need to be thought of as applying to particular populations geographically (proxy for network) and temporally; cf. tuberculosis, which has an R0 anywhere from ~0.24 to ~4.3 depending on when and where we’re talking about. Certainly we wouldn’t claim there are always exactly as many TB cases worldwide as there were yesterday.
R0 is just the number of cases expected to derive from each existing case, which isn’t the only source of new infections (you can get TB from somebody else with TB, or from contact with certain animals, or from badly mishandling a bacteria sample, etc.). It’s affected by microorganism characteristics, yes, but also by medical and public health intervention, random chance, and estimation limits.
Japan’s cases didn’t suddenly jump. Cases and deaths steadily grew at 8% for before his prediction and a month after. The problem was that people were pretending that 8% day over day exponential growth wasn’t a problem, not that the government suppressed the data.
Thanks, fixed.
I think the time axis is mislabeled on the tests per capita graph from Our World in Data. Evidence: the deaths per capita graph indicates that Sweden hit .1 deaths per million more recently than the Netherlands (because Sweden’s line is shorter in the x-direction), whereas the tests per capita graph indicates the opposite. Same goes for other pairs of countries. My guess is that the time axis on the tests per capita graph is supposed to be labeled “days since tests per capita was X” for some X. Can someone sanity check me on this?
More generally, it’s worth pointing out that the time axes on the Our World in Data graphs are normalized to different start points.
Anecdotally, that seemed to happen here in Salt Lake City. I walk my dog nearly every day, and my regular route goes through a small park and a brief section of nature trail. During the early days of our lockdown “order”, I would regularly encounter only two or three people on these walks, and the local case rate was decreasing nicely. Then, the weather turned nice, and talk of lockdowns not being helpful started happening, and suddenly I would encounter literally* just shy of a hundred people on my walk. About five days later, the local case rate started skyrocketing again, and just as suddenly my encounter rate was back down to the low single digits. (This is an anecdote, not data, and there were lots of other factors at play, but even with the weather staying nice the encounter rate hasn’t surged again.)
The best part of the crowded time: overhearing a cell phone conversation in which a man, out walking with his girlfriend, pretended that he was cooped up and bored to placate an elderly family member. He knew he was “supposed” to be staying at home, but he was treating it like a random elementary school rule, not an important public health measure.
(*I have been counting.)
(Edit: Adding to the non-data quality of my anecdote, my “local case rate” is secondhand reports through a neighbor, not any official source.)
Sigh. The parents one I can understand but there is absolutely no reason to avoid seeing SOs that you might as well have shared a living space together with, if you wanna be extra careful wait out the first two weeks. It is literally ritualistically sacrificing two people’s happiness to the gods of public appearance.
I know someone who says her sister and the sister’s husband have been segregating from each other even though they live in the same house. It really makes no sense to me. (Unless maybe they’ve been in the early phases of a relationship separation.)
The Civic Religion, as reflected in the Gospel According to Fauci, is that the spirit of COVID will appear wherever two or more true believers gather in its name…
Not civic religion as such but blue tribe signalling probably plays a role here, and some people are genuinely averse to constantly applying reductive reasoning and ad-hoc risk analysis and rather make a commitment to more stringent behavior – half of orthodox Judaism is just fences for that kind of thing.
My parents segregated for 2 weeks after my dad returned from a trip, but continually segregating for longer than that (unless one is constantly at risk of exposure due to work) seems crazy.
Unless one of them is an an unusually high risk group (someone is immune compromised or someone is a frontline health worker) this seems totally bonkers.
My girlfriend and I talked about it and worked out fairly quickly that within-house isolation was probably ineffective and definitely extremely painful, so we decided if one of us gets sick we probably both will, and any efforts we make will just be to try to avoid both of us getting the worst of it simultaneously.
It might make sense if one of them is exposed to contagion — a health care worker, say — and the other in a particularly vulnerable group.
To be fair, a lot of these people live in group houses, so if you assume that if one group house residents gets sick everyone does, and there are ten people in the house all seeing SOs, then you’re multiplying risk x 10.
Group house situations are problematic yes, if everyone involved can be relied upon to wait out the two weeks from lockdown onset and otherwise maintain quarantine and hygiene measures some sort of time-window arrangement can probably be made so that no one has to go three months without seeing their SO for less than x10 risk, unless the SOs also live each in a different grouphouse with the same situation in which case its not much of a lockdown anymore.
Seems like a reasonable way forward for at least some of these people is to make a roommate swap formal. That of course only works if people are at the point in the relationship where they are sure that cohabiting is a good idea (especially since co-quarantining is more intense than just cohabiting in normal circumstances) and if one roommate in the target house is willing to move to the SO’s former house (which is a really weird ask).
So your article on the fishtank chloroquine consumption (not hydroxychloroquine! different substances and latter is less dangerous) may contain a fair bit of conservative source bias https://www.nbcnews.com/politics/politics-news/police-say-death-arizona-man-not-being-investigated-homicide-n1195591 Dunno, quick googling online doesn’t seem to yield any new piece of news in last two weeks so no idea what is really going on.
also the twitter link comparing stockholm to nashville is pretty flawed. yes the numbers cited at the endpoints on the graphs are similar, but if you look at how things were over time you’d realize stockholm driving was down 15-20% on average while Nashville was down 40%+. Walking it’s -30-40% vs. -60%, etc. it’s down so blatantly i wonder whether it was intentionally twisted to look that way.
If I ever want to murder my spouse, remind me not to use a cover story which places me at the center of national news regarding a divisive and inflammatory political disagreement that one side would be eager to disprove.
That aspect makes me more likely to believe your skepticism of the murder explanation. The wife never claimed to be a Trump supporter in the first place, so her being a prolific Democratic donor doesn’t contradict her story. And she did get hospitalized herself, which means she was either willing to risk killing herself to kill her husband, or she had done some research on what amounts were reliably likely to kill her husband without killing herself. I would think the hospital would notice if she was faking the symptoms of a poisoning, and that the hospital and/or a coroner would notice if she used something besides fish tank cleaner on herself and/or her husband. But, ingesting fish tank cleaner is illogical in the first place, so such a murder attempt wouldn’t be all that much more illogical. But until further evidence, Hanlon’s razor would suggest the sheer stupidity is more parsimonious than malice plus stupidity.
Afaik Sweden’s bars and restaurants are operating but not as usual – inside seating is either forbidden or required to maintain certain physical distance between patrons and they are taking it seriously.
Does anyone have information on stats for religious Jews vs. religious Christians? It would have to be finer-grained than that, but if loud singing is a major risk factor, a there might be a difference.
The Conservative* synagogue my family went to had singing, but it wasn’t exactly full-throated. Play me some lousy singing of Jewish prayers, and I’m right back at my childhood. There was a cantor (one person** to do singing for the services) but no choir.
On the other hand, Chasidim (the men) do serious singing.
I have no idea how much group singing is typical in other religions.
*This doesn’t mean politically conservative, Conservative is a middling observant sort of Judaism, much more common in the US than in Israel.
**Always male when I was a kid. It was a pleasure when I first heard a woman cantor.
How services are conducted varies wildly within Christianity. You’d at least need to get down to the denomination level, and then good luck untangling the other demographic variables from that.
Yeah, as a datapoint, my Catholic parish tends to have the whole congregation singing, has several active choirs (adults, teens, kids), etc. Other parishes in the area where we occasionally attend Mass if we can’t make it to our parish have one cantor and almost nobody sings in the pews. That’s the same Christian denomination in the same county with similar demographics, but two quite different risk profiles for C19 spread.
The ideal natural experiment would be to find several churches where for some reason singing only happens every other week, or perhaps where the organ was broken on one of the weekends in March 2020, and track spreads on particular weekends.
Just attaching spreads to particular churches and particular weekends already seems tough, even if we’re not looking for a specific church with a specific set of music policies.
Has anyone done a quantitative effort post anywhere on “Sweden’s strategy is best and here are the numbers for it”?
Not “well we might as well” or “where is the effort post defending everyone else’s strategy.”
How would such a post look like without yet another rehash of how to construct the lives vs. dollars exchange rate ?
I’m totally fine with a number on that. I have absolutely no problem with it.
I still want to see what the numbers are that make it work.
The point is not that such a number cannot be put, the point is that it would be almost a pure function of the assumptions that went into creating it and would have very little persuasion power.
Yes, but understanding what assumptions would be necessary can be a good foundation for learning.
If there are not going to bother because someone would criticize the work, well, that’s a revealing answer.
From the pro-Swedish point of view, you are not changing the number of lives lost, only when they are lost. So the tradeoff is between “person months before getting sick” and other items, some measurable in dollars.
That should bring the QALY figure down by at least an order of magnitude.
Yes but that point of view is what such a study/effort-post would need to either establish or assume, an alternative would suggest that you are in fact losing more life years than you would be by locking down the country and extinguishing the diesase without reaching herd immunity.
One confounder is that the Swedish population seems to have voluntarily done a lot of the social distancing measures other countries have done, without direct government instruction. So it’s not a pure case
Italy: 0.05% of population killed by coronavirus
Sweden: 0.04% of population killed by coronavirus
Every time I see this “Sweden is doing well” meme, I wonder: compared to what?
Compared to what everyone insisted would happen if they followed the policies they are following.
Also compared to the idea that, without a lockdown, hospitals would be overwhelmed.
If you don’t believe that getting a cure or a vaccine is going to take longer than we can maintain the lockdown, that’s pretty much the only argument for the lockdown.
No, the argument for the lockdown was to bring the number of infections down to the level where the spread could be controlled via extensive contact tracing, while ramping up the production of test kits and surgical masks in the meantime.
Eh, I don’t think anyone insisted on a particular doomsday scenario. (Not that doomsday scenarios weren’t plausible or that they shouldn’t have been taken into account, we just didn’t know. We only know now because hindsight is 20/20, and we may still have an update on worst case scenario coming up courtesy of Brazil.)
Rather, what everyone was disagreeing with was the whole logic behind not doing a lockdown. Lockdowns, their opponents said, were too damaging to the economy. If Sweden was our way to test this, then the results are starting to trickle in, and it appears the damage was simply caused by the epidemic after all. We’ll still have to see how badly the control group of Denmark, Norway and Finland is doing, but with Sweden “doing well” like this, it may be hard to prove they’re doing any additional harm to themselves. Meanwhile, their body counts per capita are several times lower.
I don’t think what is happening in Sweden is what the Swedes, or anyone else, predicted. Deaths peaked a month ago and have been decreasing ever since, which seems to be caused by their voluntary social distancing. And it has happened before any R=3 herd immunity is possible. So their herd immunity strategy hasn’t worked because people have voluntarily distanced themselves to the point where the curve has been flattened. And maybe there are other factors in there like the heterogeneity of infection rate among the population, or the IFR being lower than expected, or what.
I think you can tentatively call this a success for Sweden. It means that lockdowns in other places like the US and UK, which cannot eradicate at this point, are a complete waste unless a vaccine turns up earlier than expected, because voluntary social distancing can achieve an R<1. And therefore the lockdowns in those countries are just delaying deaths, not preventing them. But it also means that Sweden's economy is still probably screwed, because the voluntary social distancing will have a big effect on the economy. And their economy will be screwed as well because the world economy is screwed.
So if I was to make a prediction now, I'd say that a year from now Sweden's deaths will look slightly worse through the whole thing, and their economy much better than countries like the UK and US. Sweden will be the king of the flatten the curve countries (even though they were really going for herd immunity). How they compare to eradicator countries like NZ depends on vaccine and border control timing.
While not defending Sweden’s plan, I’ve been willing to steelman it.
But if they really only have 5% of people infected, they haven’t really gotten any good amount of HI (herd immunity).
It might be worth having twice the deaths if it gets you from 20% HI to 60% HI. 60% HI is a huge benefit. You will notice the difference of only 40% of your population being vulnerable versus 80%.
It’s not worth having twice the deaths if it gets you from 2% HI to 5% HI. The difference between 95% being vulnerable versus 98% is not noticeable.
And any current economic advantage Sweden has bought in the meantime is negligible.
Half the deaths to date may have been possible with lockdowns in Sweden, but are those deaths just delayed until lockdowns eventually get lifted?
That 5% with antibodies measurement is from early April. Without knowing more detail about how long it takes from infection to testing positive (or the false positive rate of the test), it is hard to estimate current antibodies. But total confirmed cases have increased by four times since April 7 and total deaths have increased by six times, so there’s no way it is still 5%.
After doing a bit more research it seems Sweden could have reached herd immunity after all, which explains their declining cases.
https://www.sciencemag.org/news/2020/05/why-do-some-covid-19-patients-infect-many-others-whereas-most-don-t-spread-virus-all
CDC says that antibody tests are positive after 1-3 weeks of infection. Cases are typically confirmed a week after infection, and death after 3 weeks, so using the mean between growth in deaths and growth in cases should give us the growth in antibody positive tests. If 7.3% in Stockholm in early April, and confirmed cases and deaths increased 5x since then, Stockholm should be at 35% testing positive for antibodies today. If 25% is enough for herd immunity that would explain the declining cases and deaths a month ago.
To test this would need to see how it stacks up against the numbers in other places.
I didn’t find “antibod” or “sweden” or “stockholm” in that article. Wrong link?
I’ve posted links over the past few months suggesting both significant (plus 30% a few weeks ago) and small (5%) numbers for antibody tests in Sweden. I’m not sure which is which, and while each study seems reasonable in isolation, I haven’t seen a piece in the press try to explain which we should listen to.
And it matters a lot, because in one case the HI strategy has a reasonable chance of working, and in the other it’s a failure.
@Edward Scizorhands,
Sorry I meant to include this one:
why-herd-immunity-to-covid-19-is-reached-much-earlier-than-thought
I’m not really technically savvy enough to evaluate how well their model works in that paper, but they seem to be covering all their bases. They find that with the non-homogeneity seen elsewhere in covid-19 that herd immunity could occur around 7%-24%.
It doesn’t say anything about the seroprevalence in Sweden. My own extrapolation from the 5% studies, I haven’t seen anywhere else.
So far,
Italy: 0.53% killed by coronavirus
Sweden: 0.38% killed by coronavirus and with no lockdown.
Cool. Next, do Taiwan, Hong Kong, Singapore, South Korea, Australia, and New Zealand.
No, it’s .053% and .038% each
Sweden’s strategy turns out to be the original flatten the curve strategy, with enough social distancing to keep the hospitals from being overwhelmed. It was supposed to not be possible, but here we are.
That sort of throws out the R and herd immunity numbers. R has lowered because people voluntarily social distance, but if the cases drop too much, social distancing will decrease and R will rise again.
Without running the numbers, this has to be a better strategy than the lockdowns in the US which are accomplishing the exact same thing. Whether it is better than an eradication strategy (which is only possible in places that reacted in early stages) is harder to say.
It’s also confounded by the strategies of other countries: if everyone had locked down early and eradicated, then eradication would make more sense as borders and trade open quickly. If everyone had gone straight for herd immunity, then that makes more sense as borders and trade open up quickly. With all this middle of the road half-assed lockdown stuff it gets more complicated.
Languages differ in the amount of spittle regardless of loudness.
1) Aspirated vs unaspirated consonants.
2) The differences between the 4 or 16 variations of G even are too long to list. And too annoying.
There are so many nuances in pronunciations that only domain experts know exist. Or Polyglots.
Until someone does a real thorough study of the pronunciations, one can postulate that french/Italian/Spanish (those are almost one language, if I may….. at least linguistically very close). have those pronunciation details that blow more or different types of spittle
3) Spittle is not about volume. It is also about type, velocity, and this one that stays longest in the air and travels farthest.
Very nonlinear. And not necessarily intuitive!
Added:
4) See the comment below with a link for a study on vowels and stuff.
5) Singapore would support the language hypothesis. Singapore is an outlier in the intensity of its spread. But its language is mainly English. So it might explain
There’s been at least some measurement of this: https://languagelog.ldc.upenn.edu/nll/?p=46957
The bigger effect I think is that different cultures have different ‘personal space.’ Italians are known for standing very close and being very touchy feely. Germans and Japanese not so much.
I’m tempted to argue the insanity-wolf position of forced ripping – reopen everything, ban masks, ban working from home, infect as many people as possible, no sleep ’til herd immunity. I know this is a terrible idea but all the other ideas are terrible too.
I cringe every time I hear someone talk about “economic harm.” It sounds like a callous Mr. Moneybags sniping about losing a few percent in his stock portfolio. That’s not the main harm caused by the lockdowns. We’re talking about not being able to live life anymore, being trapped in one’s home, cut off from all social contact. I’m a hyper-introvert who could barely stand the limited social interactions of office life and after two months at home I’m going stir-crazy; imagine how normal people feel!
What I would like to see mentioned more is the simple fact that being rich is what allows us to have hospitals to treat these (and many other) maladies. It is a completely false dichotomy to talk about one vs the other in this scenario.
Can hospitals do much for Corona sufferers? I understand ventilators turned out to be a mixed bag at best. We’ve got oxygen masks; anything better?
According to Steve Sailer on Twitter, the most effective treatment has been “roll them over onto their stomachs”
I think one of the biggest discoveries was that a lot of people who had low pulse-ox scores but were not in any apparent distress didn’t need to be put on a ventilator.
What do they need, though?
As one example children with Kawasaki (and the similar Syndrom propably induced by Corona-SARS2) can be easily treated but need hospital care.
Also those who get heart and/or kidney damage probably benefit from stationary care.
This seems to be the reaction of most of my liberal friends, and honestly, with all due respect, y’all need to get over this visceral but counterproductive and frankly callous reaction. (Note: following rant directed mostly at them, don’t take this too personally)
This isn’t “murder grandma for Mr. Moneybags’ portfolio” this is 20 million+ people who had a job in the US as of March 1 no longer getting a paycheck. This is “Essentially nobody in the restaurant, tourism, entertainment, or small retail industry turns a profit this year and a significant fraction will go bankrupt”. This is millions of people needing to delay retirement by years, spending a big chunk of their remaining QALY pool, because their 401ks took a big hit at the worst time. That’s what economic harm looks like – lots of people other than Mr. Moneybags rely on a healthy economy!
It’s extremely frustrating watching people who have to work from home but are otherwise economically secure criticizing people whose livelihoods have been destroyed by executive order as insensitive. You’re absolutely right that being trapped at home is itself an underrated and serious harm, but I think your are wrong to downplay the extent to which the economic impacts are primarily of the “rich get slightly less rich” sort.
But they’ll get their Stimulus Check instead, which is just as good as a paycheck but better because it doesn’t make you work a demeaning low-class job. And it’s being payed for by taxing Mr. Moneybags’ portfoloio, or borrowing money from him that we don’t really have to ever pay back, right? So the Republicans and the Libertarians really are just in it to protect Mr. Moneybags at the expense of all the little people.
/sarcasm, but that’s a tough argument to counter for the true believers.
This is my “this, but unironically” position.
The reason we want to keep people away from those “low-class” jobs isn’t because we think they’re demeaning, it’s because those jobs can’t be worked at from home, and pose more of a risk for spread. That’s why stimulus checks, or some sort of temporary UBI, may be preferable to sending low-wage workers back to restaurants and meat-packing plants. I’m leaning towards this even if the revenue for it does not come solely from Mr. Moneybags, and comes from average taxpayers, and under the belief that we should “pay it back” once we have a vaccine or some strategy that approaches the power of a vaccine.
And I don’t see why it’s unreasonable to suspect wealthy decision-makers may be willing to needlessly make poorer people dependent on working during a pandemic because they’re heavily motivated by stock market investments decoupled from the well-being of the average person and find the idea of handouts ideologically nauseating.
I’m not saying paying people stimulus checks if you’re going to destroy their jobs is bad policy.
I AM saying if you’re going to dismiss the “economic harm” as something only Mr. Moneybags ought to care about, you’re the one being “callous”. Not the low income now unemployed worker who gets a couple checks and a lot of uncertainty, nor the small business owner likely to go bankrupt even with bailout money, who are complaining about the lockdown that was started and then repeatedly extended by executive fiat.
And how many of those people still have a job if state and federal governments did nothing instead? How many people are going to Disney World when COVID-19 is running rampant? How many go to restaurants? How many people have to quite jobs to care for sick family member? There are broad economic consequences to COVID-19 regardless of what governments do.
This right here? This was probably happening regardless. You could even argue that banning in-door seating for a couple months, governments made it easier for places to stay in business by making curb-side pickup a thing. I’ve eaten out a ton during the epidemic via curbside/delivery. Many of those places wouldn’t have have received my patronage if they’d only been open for interior dining.
Point is, it’s complicated, and attributing all the economic consequences to the response and none to the virus doesn’t make for productive discussion.
We have mobility data from Belarus (only country with almost zero restrictions on anything) that show that restaurant attendance has gone down by ~15% (https://www.gstatic.com/covid19/mobility/2020-05-13_BY_Mobility_Report_en.pdf). Nothing to scoff at, but better than nothing.
If the government did nothing, restaurants would have plenty of opportunity to creatively lure in customers. Restaurants would start competing on who could build up the safest experience – you’d see waiters wearing masks, plastic dividers between tables, open windows for maximum ventilation, etc. The free market would’ve sorted it out just fine.
I’m pretty sure restaurant business was down more than 15% in the US even before they were officially forced to close.
And most restaurants have to be basically packed in order to stay in business. Saying “you can reopen if you remove half the seating” is a death sentence, not a mercy.
Sure, some would manage to stay in business, but the vast majority would have been forced to close by economics in any case. At least when they were closed by official order, that allows the government to provide financial support.
The government isn’t allowed to provide financial support to a business or industry unless it has ordered that industry’s closure? I did not know that.
John Schilling – it’s not that it’s *impossible* to provide financial support to businesses that haven’t been ordered closed. But it becomes a lot more difficult to calculate what people consider “fair” to give businesses. If one business is able to be 40% full while the other is only 20% full, do you subsidize the one at 60% of normal revenue and the other at 80%, or some different amount? Do you give workers unemployment payments based on whether they choose to go into work, or only based on whether their employer asks them to?
Keeping small businesses alive is the hardest part of the economic angle of this.
You can dump money on people pretty easily. What do we do about businesses with high fixed costs? Those that have to keep running 24/7 to stop stuff from breaking? Those that are better being completely closed than 50% open?
There’s a lot to not like about how the PPP helped small businesses, but it was always going to be an incredibly hard problem.
But that’s not what I’m doing, at all. My rant was prompted by the comment:
A Democratic senator yesterday asked Steve Mnuchin how many deaths he was willing to trade for 1000 points on the Dow.
My FB feed is full of people who seem to think the only reason to be bothered by the lockdowns is that you are an entitled crybaby willing to kill grandma for a haircut.
Are those productive ways to have a discussion?
I’m not taking a strong stance on the wisdom of lockdowns in their current form. It’s a legitimately hard question. And you’re right that the proper point of comparison for any net harm due to lockdowns is not “business as usual pre-COVID”.
What I object to is the dismissal of “economic harm” as a mere abstraction felt only in corporate boardrooms and the portfolios of the rich. The impacts are real, significant, and being felt across the economic spectrum, with lower classes, informal/gig workers, and small businesses being in many cases the hardest hit.
That’s fair, and I agree with you that the full range of consequences from government interventions taken in response to the pandemic should be part of the discussion. I just think there’s a tendancy to attribute any delta between our current world and our expectations for what things would’ve been like without the pandemic to the response to the pandemic rather than to the pandemic itself. Dead people isn’t the only consequence of a virus running rampant through society.
If the governments did absolutely nothing then the pandemic would be over by July. How much economic damage during that time depends on how much panic is whipped up by the media.
With the interventions the damage will continue indefinitely but probably until there is a vaccine, which means not only do you have all the economic harm a lot longer, but businesses can’t plan for the future, which means resources don’t get reallocated and the economy just gets worse and worse. It is really bad if a quarter of small businesses fail right away: it is much worse if they spend 6 or 10 months trying to hang on and then fail anyway. That’s six months of cash reserves eaten up, six months of employees doing unproductive work, six months of capital not being reallocated. It means consumption decreases because nobody knows what is going to happen in 12 months. It means that someone with an idea for a new business doesn’t bother trying because the future is too risky, so nothing replaces the jobs of the failed businesses.
I think that ignores the likely reaction of the public. The government doing nothing doesn’t mean customers keep taking cruises and flights and riding crowded public transit and going to restaurants and such–it means the government doesn’t *forbid* any of those things. But there were big drops restaurant and theater attendance and flights taken and such without any government action. That would slow the spread of the virus quite a bit, and it would probably not be all over by July.
I mean, we can watch and see if it’s all over in Sweden by July–that’s our control group, who have taken minimal government actions. (Probably about the least of any realistic government response–advise high-risk people to be extra careful but otherwise let things run pretty normally.) I don’t think it will be, but I’m certainly willing to find out I’m wrong.
As far as panic whipped up by the media, consider what happened in NYC even *with* the (later than they should have been) lockdowns. The only way there’s not going to be panic from that situation is if the media all impose some kind of news blackout on the subject. (And then it would cause even more panic once the truth got out.)
There was sorta a news blackout for the 1918 Spanish Flu. And it wasn’t over in a few months. It kept on going and really did its worst in the second wave in the fall.
This depends on your definition for “minimal”.
If you define it as “the lowest amount of formal Government interventions in the West”, sure.
If you define it as “least change in behavior in the West”, then it’s arguable depending on which metric you look at. (On some metrics, Sweden is an outlier for low changes. In others, they’re the lowest but e.g., Denmark and Norway are pretty close. In at least one, they’re on the higher side.)
If you define it as “did nothing”, then it’s obviously not true.
If you define it as “do as little as folks who oppose lockdowns are advocating”, then it depends on who specifically you’re talking about. I find that there’s a lot of motte-and-bailey that happens with the lockdowns, with “Sweden” as the motte and “No Government restrictions on freedoms” as the bailey. Sweden didn’t do “nothing”, they basically the same types of thing everyone else did, just less strict.
Matthewravery:
So, is there any way we could test to see whether your prediction or mine are more accurate?
The Sweden thing is strange. Their daily deaths peaked April 23 and have been slowly decreasing ever since. As of April 29th 20-25% of the population of Stockholm county had been infected lancet.
So that indicates that voluntary social distancing is effective, and/or herd immunity is reached earlier than what thought, and/or the IFR is probably .5% or so. Which is all good news.
So when do we declare it ‘over’ in Sweden? And when can we decide if they won or lost?
And, how does the data from Sweden compare to other places? Is it applicable?
There are only two obviously wrong people here, not really through their own fault: the “Flatten the Curve is a Deadly Delusion” guy and Neil Ferguson. Turns out that flattening the curve to keep hospitals from being overwhelmed was entirely feasible. I took them at face value, as many others did, which left the options of herd immunity or eradication.
@Albatross11-
Which prediction? I generally try to avoid making predictions about COVID. I think it’s a fool’s game given how little we know about the virus. My most recent comment in this thread was quibbling with your description of Sweden’s policies as “minimal” without given a clear definition of what you meant by “minimal”.
(Aside from people’s tendency to generally being over-sure of their own positions, the part of COVID-19 discourse that frustrates me the most is the lack of precise language.)
Realistically, most restaurants would have gone bankrupt anyway. Unless you’re proposing forcing people to go to restaurants against their will, even as people die all around them.
One thing that really bugs me is that lockdown opponents seem to be comparing the status quo to some hypothetical world where nothing bad happened, rather than any actually achievable alternative.
Yeah, at least around here, a lot of restaurants seem to have many patrons in their 50s, 60s, and 70s. While C19 is a serious concern, most of those folks aren’t going to sit in a restaurant….
The non insane version of that would be deliberately exposing small portions of the population, starting with the youngest and healthiest, at a rate hospitals could cope with, to develop herd immunity
People being able to live their lives has a lot of overlap with the economy. For a personal example, my brother is getting married in 2 months in a different province. If the current rules are still in effect I won’t be able to be there. While missing a wedding isn’t an economic harm, it contributes a few: if I can’t make the trip, I wouldn’t buy gas, book an AirBnB, or patronize some restaurants and cafés that I otherwise would. The economic harms are the (easier to measure) shadow that’s cast by people having to put aspects of our lives on pause.
I think actually we *should* think of missing the wedding as the primary “economic harm” here. At least, economic theory is supposed to be about people getting what they want in a situation of scarce resources. All the talk of monetary and fiscal measurements like GDP is an approximation of that (and often a good one, since most things outside the home that people want will involve measurable transactions with others).
Of course, apart from that point, the question about whether or not you’ll be at the wedding is presumably not just about what the rules are like, but also what the actual public health circumstances are like. If the number of people getting sick every day in the location where the wedding is looks like Lombardy or New York in late March, then I would guess that the wedding in the sense of a large gathering of social acquaintances probably won’t happen, regardless of what the rules say.
> If there’s a 50% chance of a definitive solution in one year, is it worth staying locked down until then?…
You’re using the country as the actor, but I think it’s at least as interesting to find the nash equilibrium for individuals.
Someone might wonder, “If there’s a 50% chance of herd immunity in a year, can I stay more isolated while others are forced to go about their business and take the risks to help protect me?”
We end up sorting society to find the 10% most reclusive (trust funded introverts, say?).
We need a metaphor that’s the opposite of being faster than the slowest rabbit.
Like, you want to be a third-row penguin (neither pushed, nor a pusher, but still pretty close to the food):
http://www.readthehook.com/82891/strange-true-penguin-push-how-killer-whale-gets-his-meal
> (if you want to go a different direction, you can add “= 0.1 black people murdered by cops”)
You know this is the throwaway line that you’re going to regret writing at some point, right?
There are a lot more police shootings of black people than there are kidnappings of kids by strangers, and each of the latter seems to make nationwide cable news, while before 2015 almost none of the former did. Remember that Twitter isn’t real life.
(Personally I’d place it roughly in the “100 Europeans die in a plane crash” category. But to place it at the very bottom is just baffling.)
That single line makes me cringe to share a post I’m otherwise excited about.
FWIW the number of stranger abductions annually is about 100.
So it’s on the same order of magnitude as black people killed by police (which we covered in an open thread recently, is somewhere in the low hundreds). We could quibble about which is more likely to get coverage – in both cases I think most cases receive only local coverage (a lot of kidnappings get resolved quickly, a lot of police shootings are fairly uncontroversial (guy gets shot in a shootout / suicide by cop / trying to ram a cop with his car or whatever))
I do agree the line seems out of place in the article (in a “needlessly likely to cause controversy off topic comment” way).
EDIT: is “pretty white girl gets abducted” an out of date reference? I remember a brief period years ago where these seemed to be on the news all the time, but I honestly can’t remember the last kidnapping case that got the same level of nationwide coverage as e.g. the Arbery shooting.
>EDIT: is “pretty white girl gets abducted” an out of date reference? I remember a brief period years ago where these seemed to be on the news all the time, but I honestly can’t remember the last kidnapping case that got the same level of nationwide coverage as e.g. the Arbery shooting.
Mollie Tibbetts, 2018
To be honest, I didn’t recognize the name, and when I looked it up I remember it being national news mostly because the murderer was an illegal immigrant (another controversial area of risk that gets hyped out of proportion to its prevalence! But not quite the one I was thinking of).
A quick Google search shows ~200 police shootings of blacks per year and ~350 stranger kidnappings per year, do you disagree with these numbers?
I also found that line jarring.
Police shootings data is notoriously difficult to collect (essentially impossible, before a few years ago), but I think I spotted your source and with the “on-duty” qualifier in mind I don’t really have any complaints.
Here too, but note that the “pretty white girl” qualifiers have vanished. It turns out that girls seem to be abducted more frequently, and while the racial data is confounded it doesn’t appear to be too far off of base rates. No comment on “pretty”. Cut the number in half, and I’ll be satisfied.
So with that adjustment, the two groups are just about the same size. The difference then, will be found in the numerator – which cases get more media attention? I’ll continue to say that this is a metric that is difficult to study and impossible to define beyond the crudest sort of general-interest review. I don’t think there’s enough evidence to be confident about an order of magnitude difference between the two either way, but gun to my head I’d venture a guess of the kidnapping getting ~2-3 times the media traction as the shooting.
Note that the “pretty white girl” qualifiers have vanished.
To be fair, Scott did say “0.1 black people murdered by cops”, and not all black people killed by cops are murders, either.
Murder was switched to shootings and kidnappings added “stranger” – I think both do a better job matching the categories we’re actually talking about, and don’ object to the shift.
Because if we’re going with a strict definition of murder I have difficulty thinking of any cases beyond Botham Jean; surely we’re in single-digit or less per year. That’d be a cheap argument though, as with qualified immunity being what it is these days actually holding an officer accountable for murder basically requires extraordinary circumstances.
I looked up the number of police shootings of unarmed black people, but I honestly didn’t expect the number of stranger abductions to be that high.
I apologize for not looking up that side of things; the two should indeed be placed on the same order of magnitude of harm, and I think they’re also within an order of magnitude in terms of cable media attention (I don’t watch Fox News to see how many kidnappings they make into national news, but it’s going to be more than the number of wrongful police shootings of black people they report on). The ratio of attention to harm is probably higher for the shootings, but not by a 10x factor.
(That being said, I do agree with Alkatyn that a pattern of unpunished police violence ought to be more newsworthy than unconnected crimes. But I wasn’t thinking of that argument when I initially commented.)
Thanks for politely telling me the statistics, and I’m sorry I failed to check them.
Also. The net number isn’t the only issue. Its that agents of the state are killing citizens, and frequently not being punished due to systemic corruption. You’d think given Scott’s libertarian leanings he might understand why that’s an issue
re the vote by mail thing. Nate talked about the oddness of the data not showing it helps a particular party, but the republicans being massively against it, on the 538 podcast. My understanding (and people can correct me if I’m wrong here) is that in the past marginal increases in vote by mail in some states have helped democrats, but overall making vote by mail available to everyone doesn’t help or hurt anyone in particular. And republican opposition to vote by mail for the years election is partly a hangover from their past opposition to it, and partly not wanting to set a precedent for making big federal efforts to increase voter participation
I have gotten a lot of flak, both online and IRL, for expressing my discontent with the lockdown. And this is one of the things that pisses me off. My frustration with the lockdown measures (the lockdown measures in my city) has been that they are arbitrary and crude, and enforced with waaaaay too much oppression (on paper; in practice they’ve been basically ignored). For most of the last six weeks, it was literally a crime punishable by up to six months in jail to go visit your boyfriend or girlfriend. I haven’t been saying “This is all stupid we should just go back to normal”, I’ve been saying “even the nazis didn’t throw you in a concentration camp _just_ for visiting your loved ones” and I’ve gotten pushback from people I’ve known for years hysterically screaming at me that I’m going to get us all killed. And the thing that makes it so goddamn frustrating is that I just know that each and every one of them are breaking the exact same rules I’m upset at. They don’t care when they do it, but then they scream at me for saying “hey, look, these rules are dumb and everyone breaks them anyway, can we just drop the whole jail time for hanging out at your friends house thing?”.
It’s like the people around me have an active preference for hypocrisy: they want it to be illegal but they also want to break it but they also want to punish others for breaking it. I don’t understand why so many people have settled on this point of view and to be honest it’s starting to make me actually scared for my safety, because the only way I can square it is by hypothesizing that these people actually just want excuses to exercise arbitrary authority, and don’t actually care about fairness (since they’re breaking the rules) or efficacy (because if you are following all the other rules responsibly and then just go and hang out with your friend, who is also following all of the other rules responsibly, then the marginal increase in your risk is literally zero)
+1
This is roughly my read of the situation as well.
Have you read Robin Hanson? He has a lot to say about the apparent preference for hypocrisy you’ve noticed.
There are many laws like this on the books — draconian on paper, often not enforced. Speed limits is the easiest example — going 1mph over is still a punishable offense. Public disturbance rules as well — they’re often not enforced in situations they could be, but the threat being there means people know they can’t flagrantly ignore them.
One purpose of writing them like this is, it makes it harder to follow the letter of the law but not the meaning. Provided they’re enforced at commonly acceptable levels this can work out in a practical sense. And of course, the downside is they can be abused.
In the same way, the rules around social distancing are, in my opinion, a mix between the government making a strong recommendation, and at threat of enforcement that can be used against extreme rule-breaking. You do want to be able to legally stop the guy that runs around touching everyone’s face, and while the laws are clearly overly broad for just that, so long as they’re not throwing grandmas in jail the practical effects are roughly what we want.
Whether one is happy or sad with this situation comes down to how much trust you have in the enforcing institution.
@DavidFriedman maybe you can say more about this? I think there’s a good opinion here but I didn’t spell it out as clearly as it deserves.
Not everywhere- lots of European countries have a tolerance, either in law or in official police guidelines.
Most of the United States has rules about this too – there are some jurisdictions where there is police discretion about stopping people who are exceeding the speed limit by less than 10 mph, but in most jurisdictions I believe they’re not allowed to unless there is some other violation as well.
I’ve seen no shortage of this myself, but mostly kept my own mouth shut except for here so I haven’t experienced the worst of it myself. One of the things I find particularly objectionable is the counterargument that it doesn’t matter if the policies are arbitrary and crude, or even if they don’t actually help, we all have to be on board with them because that’s how we “come together” and “demonstrate solidarity” and “present a united front” and so forth.
Which is one more problem with the fact that we’ve made a civic religion out of what should be a pragmatic adaptation to a crisis. A pragmatic crisis response, you can be pragmatic about the imperfections and not treat every deviation as an intolerable assault on righteousness. A civic religion, can tolerate no dissent. It isn’t enough that most people socially distance or wear masks or stay locked down, because it’s no longer about what level of adherence to such policies drives R<1. And it doesn't require the believers to be perfect in their own adherence, so long as they mean well and don't make a virtue of their private hypocrisy. It's about keeping the faith that We Are Right, because it's the faith that makes the fear go away – particularly faith made manifest in the punishment of unbelievers, because outrage usually trumps fear.
Unfortunately, faith also sometimes makes new ideas go away, and it's absolute murder on admitting that any of your old ideas were even a little bit wrong.
I heard someone else describe this as the biggest mass-hysteria in America since the Salem Witch Trials, and I’m not sure that’s very far off…
Except we aren’t going to get a Giles Corey so we realize the monstrosity of what we’re doing.
+1
It was inevitable that this would all turn into moral crusades and outgroup bashing/virtue signaling. Which is pretty annoying, since what we need is careful thinking and sensible risk management and accumulation of new evidence that updates our behavior.
What is annoying is that lots of people were already shifting their behavior, you know like adults, as things got scarier and yet we are mostly having an argument around assumptions that you need government to step in to get things done.
Possibly related to the hypocrisy discussion: it seems to me that the old adage that “actions speak louder than words” has been slowly reversing so that the opposite is true, both when individuals evaluate their own actions and those of others.
There is a third level of abstraction that is also gaining ascendancy over actions and words, which is something like “mood affiliation”, which typically assigns good or bad intentions to a person who has not voiced such intentions or performed any actions from which such intentions can be reliably inferred. Rather, their intentions are derived according to what types of people they associate with, what tribe they’re in, etc.
So, mood affiliation/what I say your motives are > your own words, which in turn > your own actions.
For the purposes of comparing pandemic response measures to Nazi concentration camp policy, don’t you think the fact that
is more important than it usually is?
I mean, if the Nazis said that Jews were to be sent to concentration camps and exterminated on paper, but in practice not a single Jew was ever molested by the government, I’d still think that on-paper declaration would be pretty troubling. (Similarly I think Trump suggesting flag-burners should lose their citizenship and claiming he has “total authority” over states is a disqualifying problem of his even if no flag-burner is in danger of losing their citizenship and Trump doesn’t manage to obliterate states’ rights.) But here it seems pretty clear to me that state governments don’t want to arrest anyone. They want to arrest as few people as possible because each time they do (unless it’s one of the universally-despised guys who run down supermarket aisles licking everything in sight) that decreases public acceptance of the measures and cooperation, which is their ultimate goal.
And I just am not seeing people going crazily finger-pointing in my own personal life, even though I’m surrounded by pretty liberal and leftwing people. The worst I see is this sort of face-palming reaction to social distancing violations.
On the other hand, if all the Jews in Germany would have peacefully surrendered all of their physical property and left Europe once the Nazis came into power, the round-ups and the camps wouldn’t have happened, right?
The main reason the government isn’t harassing people right now is because most people are complying with their dictates. Once that shifts, it will be interesting to see what happens. In Texas the answer is pretty clearly “we were bluffing, you can do what you want.” I’m not sure that will hold up in California or New York though…
It also gives those people standing to challenge the law in court, which means you would have to defend a First Amendment reading where the government can punish non-political peaceable assemblies.
Maybe the reason you get such vigorous pushback is that you’re comparing unenforced social safety measures to concentration camps.
Yeah, comparing anything to Nazis is a reliable way to get a strong emotional reaction. Anyone who wants to avoid strong emotional reactions to their arguments should cut their Nazi comparisons to zero.
Incidentally, I’ve been thinking the better Nazi metaphor is the other one. Ending the lockdown measures right now because they’re no fun would be like surrendering in February 1941 because the wartime economy and drafts are no fun. I mean, what’s the cost? They only want to kill the jews and homosexuals, just like the virus only wants to kill the old people and people with diabetes. Why can’t we just appease them and surrender?
People also accuse me of breaking the rules when I criticize them.
I criticize them, and follow them, because the law is the law, and the things I’d like to do, I can’t do anyway because the businesses in question are closed.
Everybody seems to assume that just because I say: “This is crazy, children should not be locked down in tiny apartments for a month without being outside”, I am going around spreading the coronavirus.
In London Today the Police Behaved Disgracefully
An article written May 9 about how the police are behaving in London:
And here’s another by the same author describing his view of the effects of lockdown on Britain:
link text
From the link: “There will be no hugging of people from outside your household until autumn at the earliest, says Matt Hancock, the secretary of state for [Health and Social Care]”. So, thanks for showing California that we’re not uniquely bad at this, I guess?
Outside of California, at least, the United States has political division on its side, making it harder to convince the entire population to surrender to fear and unite around the suspension of basic liberties as O’Neill suggests is happening in the UK. But the price of having maybe half a nation still OK with liberty going forward, is going to be an even deeper divide between that half and the other.
I’ve noticed this sort of messaging pivot at my employer (a large international corporation). A couple months ago, all the official emails were saying “make arrangements to work from home if at all possible.” Now they’re all about the enhanced safety precautions the offices have implemented, and how studies have shown that productivity is better in the office, and how everyone is expected to return as part of our phased-in plan, etc.
The unstated implication definitely flipped from “good employees will stay home” to “good employees will come back.”
There is a Klingon saying: “The wind does not respect a fool.” In the time of Kahless, a furious storm approached a city. One warrior stood outside the walls and refused to seek shelter, saying “I will make the wind respect me.” The next morning, he was found dead.
The first wave of the 1918 pandemic targeted children and the elderly. The second wave mutated and killed mostly 20-40 year olds. This age range eventually constituted nearly half of deaths in the US.
This thing could change. If not this, it could be something else. Antibiotic resistant bacteria. Reston virus could jump to humans. Then it won’t be “lots of people” dying, it could be you and your loved ones.
I have this crazy idea where we make policy decisions based on actual cost-benefit analyses done with reference to what we actually know about the problems we actually have, rather than by following the path of least emotional resistance. Perhaps I’m insufficiently Klingon.
Would embracing Klingon political values mean that we get to decide the 2020 election by having Trump and Biden fight a duel to the death? I might be onboard for that!
Either that or Patrick Stewart just picks his favorite, I think.
Ok, but those are just as likely to happen at any time, they’ve got nothing to do with the coronavirus currently out there. If your position is that these justify lockdowns now, they also justify lockdowns forever, even if and when we have a 100% effective vaccine against COVID-19.
40% of US COVID deaths are in nursing homes. And the real number is probably over 50%, but New York is doing a kind of sketchy thing where they only count it as a “nursing home death” if they actually die there – old sick people who catch COVID in a nursing home then die in a hospital aren’t counted.
If the median COVID death is a resident of an assisted living facility, 10 years does seem like a high estimate for years lost (and certainly, basically by definition, someone in an assisted living facility or nursing home is not living 1 QALY per calendar year).
I saw noted elsewhere the good point that “Coronavirus doesn’t kill the old, it kills the sick (i.e. almost everyone who dies has some comorbidity), it’s just that old people are much more likely to be sick”
Doesn’t this suggest that “strict quarantine of nursing homes and immune compromised people” would yield most of the bang for much less of the bucks of a full lockdown? If herd immunity is the only way this ends, “get herd immunity among the healthy while the sick hunker down” seems like it ought to be on the table, especially since the people who would need to hunker down are generally less economically productive anyway (making the disruption small).
I’m beginning to think this would have been the way to go.
It’s not just deaths that are concentrated in nursing homes, cases are too. In Ontario long-term care home residents account for 18.1% of all known cases in the province, with workers there accounting for another 6.2%. I don’t have a good explanation as to why.
I mean, isn’t the explanation simply that nursing homes contain a lot of vulnerable people in close proximity? Easy to spread there, and lots of very sick people means the relatively healthier workers are getting a big dose of exposure.
They probably get tested much more frequently too – the old/sick are probably getting sick enough to get tested more often than the average infection outside this population, which would be likely to be mild or asymptomatic.
What’s the best example of some place isolating the elderly, either alone or as part of a wider strategy?
I think at this point most places are isolating nursing homes / restricting visitors. I’m not sure if there are large places doing essentially only that and nothing else?
Restricting visitors is good, but lots of nursing homes are still being overwhelmed, because workers come and go and sometimes even move between facilities.
So who has done the best job of taking the task of “isolating nursing homes” seriously? What’s the best region or country we can point to and say “look, these guys, look at them, they’ve shown us how you actually do the job, follow their model”?
See my other comment, but it seems like NY and Pennsylvannia did the opposite of this by sending corona patients back into the nursing homes, even if they otherwise restricted visitors.
Also, if you are young and healthy and your significant other is young and healthy, and neither person spends time in close contact with at-risk people (who should themselves be taking their own precautions), the chances of you hanging out together having an appreciable impact on the virus spread are vanishingly small.
I think Arnold Kling has been making roughly this argument since very close to the beginning.
EDIT: I accidentally block-quoted myself. The actual block quote I meant to make has been supplied.
That fact that so few people cite Kling is evidence that we aren’t a rational species.
This would be better than nothing, but I think one objection is that you can never completely isolate the old and sick – there will always be a few points of entry (carers, relatives, etc). If 1% of carers and relatives get coronavirus, that’s a really different situation for the old and sick than if 50% of carers and relatives get coronavirus.
I think the UK was originally going to try this strategy, but backed down when they realized there might be ventilator shortages that would kill some young people. Now that ventilator shortages seem less pressing, maybe it will get revisited and people will do the calculations properly.
I thought the whole issue was that “keep things so locked down such that only 1% of caregivers and relatives ever get infected” is not really looking viable anymore?
Most nursing homes are already banning visitors, so that solves the relatives problem (letting it burn through the healthy community shortens the duration of the visitor ban – better for the residents!).
Caregivers are a bigger problem – you would probably need to incentivize those people to truly self quarantine, test every day, maybe operate in shifts where they stay at the nursing facility for a couple weeks, etc. Perhaps you could subdivide the populations at the homes (Alice through Esther stay over here with caregivers Bob and Carl, Francine through Martha stay over here with caregivers Diana and Emma…). For old folks staying at home but needing help from relatives, well, those people are already at a greater incentive to effectively self-isolate since it’s their grandma they are saving.
You could throw a stupid amount of resources at those limited problems and still be much cheaper than the “shut down everything non-essential for months” approach, while still saving most of the lives. And most of what you would need to do for the elderly is just a stricter version of what should already be best practices at the current level of infection risk.
The problem is, IME at least, “caregiver at a nursing home” was already, even prior to all of this, one of the crappiest, least enjoyable, and lowest-status service-industry jobs there is.
Making it even worse, by giving it requirements like “oh and as soon as you’re off work you have to stay in this dormitory and never see your friends again until all this is over (which may take several years), at a time when other essential service industry options such as grocery store check-out clerk and amazon warehouse worker are raising wages and hiring more people, is basically a non-starter.
So the government can subsidize caregiver salaries to pay them a whole lot more. Still probably cheaper than society-wide lockdown.
Broadly, capitalism knows how to solve the problem of “no one wants to take this job because it sucks.” We just keep stubbornly rejecting the known solution.
You could make it more palatable by having a on-off schedule like nurses, airline pilots, and oilfield workers do. You’d get all your work for the month done in one run (including a paid 3 days just being quarantined and tested at the start of it), then you get a big contiguous block of free time afterwards. It’d still suck (and only work for people with no dependents) and you’d still need massive raises to keep sufficient numbers of people around, but given our current budget for COVID is essentially “all the money”, this would still be cheaper.
Considering the US government just tossed $600 billion at workers I am pretty sure that level of the problem is solvable.
It’s technically solvable but I don’t know if it’s politically feasible.
“Let’s single-out a specific occupation and dramatically decrease their rights and freedoms, but we’ll print some money to throw at them for compensation” seems like something that would be rather contentious, to say the least…
For better or worse (mostly worse, IMO), pretty much every political response to this issue so far has taken “treat everyone equally” as the highest and least flexible value. Could we have a more economically efficient response if we were willing to violate that? Sure. Is anyone actually willing to violate that? I’m skeptical.
If it’s feasible for e.g. workers on offshore oil rigs, why wouldn’t it be feasible for senior caregivers?
Nobody is suggesting compiling a list of everyone who was working in that capacity three months ago and saying “now here’s the new deal, and here are the men with guns who will shoot you if you don’t take the new deal”. I mean, if we put the government in charge, some of them will suggest that, but it’s a stupid idea and we don’t need to do it that way.
Offer people enough time off between shifts and enough extra pay, and they’ll line up to volunteer. We know this. As Evan Þ says, this is a solved problem in capitalism.
As with most other things, ample cash, sufficient PPE and widely-available tests make it work a lot better.
There’s a problem with the isolating nursing homes solution though. A lot of people will be upset if they’re not allowed to visit their elderly loved ones, especially when those loved ones get close to death.
And what about the mental health impact on the nursing home residents, for that matter?
Uh, this part has already happened anyway, basically everywhere. And people who complain about it are told to shut up because if they violate it their grandma will die.
But their grandma is dying anyway, because the home is bringing in COVID-positive old people because the government says they have to.
So we get the worst of all worlds situation where old people are dying alone, with friends and family nearby who aren’t allowed to see them, because if they saw them, they might transmit an illness that could kill them. And then even after they die, you can’t hold a funeral to honor/remember your loved ones, because that violates prohibitions on group gatherings…
(I believe my comment here is true and necessary.)
Can we not do this? Can we not be deliberately dense?
Look, if you hate the lockdowns and think they are the wrong way forward, okay. We get it. That might even turn out to be right.
But when people discuss alternatives to the current path, especially if one doesn’t like the current path, don’t pour sand in the gears of the conversation by proposing deliberately bad and evil ways of implementing those alternatives. “Let everyone else be free but seriously protect the elderly” is an entirely plausible plan.
Now, maybe it will end up not working. Maybe the money it would take to get workers to follow enhanced safety guidelines is going to be more than the trillions we are otherwise giving up. I could see that being possible. But let’s check and see instead of deliberately ruining the idea, especially since this idea is being proposed as an alternative to a status quo some people hate.
The government was requiring nursing homes to take in COVID-19-positive people when they were discharged from the hospital in some states, notably New York. (Cuomo seems to me to have a much better reputation for his COVID-fighting skills than is justified by the record.)
But nursing homes and retirement communities everywhere have locked down to keep visitors out. What the hell else could they reasonably do, knowing that having C19 introduced into their facility is likely to kill off a bunch of their patients? I’d say anyone running such a facility who *didn’t* do that would be negligent.
Matt, I know you’re opposed to the C19 lockdowns, but I don’t think it’s reasonable to cast every single C19-related policy as oppressive and evil. I wish you’d play by mistake-theory rules here at SSC, instead of conflict-theory rules, because I think you have real points to make, but then you also toss off nonsense like this.
How is it nonsense?
A “no visitors” policy makes sense if justified by “because this will help us keep COVID out.”
But then if you can’t keep COVID out despite having no visitors, forbidding people from seeing their dying relatives in their final moments is just cruel. I’ve read too many tearful social media posts of people whose relatives have died alone, needlessly, to not be upset about this. I can’t even imagine how much more angry I would be if this sort of thing happened to me personally.
The vast majority of my objections are of this nature. Something like “X would be justified if it actually stopped the spread of COVID, but it isn’t actually stopping the spread, therefore you should probably knock it off and let people be free.”
If you can prove to me that a particular policy is actually successful in protecting a particular group, then we can have a reasonable mistake-theory discussion on whether the costs are worth the benefits.
But as the first part of Scott’s post here explains, so far there’s basically no evidence that any of this is doing any good whatsoever.
“This policy won’t work 100% of the time” or “this policy is just delaying things” were both arguments against border screenings, too. And I thought they were bad, then, too.
Now, maybe the cost for doing [border screening / nursing home lockdown] is not worth the benefit of [buying N days on pandemic / keeping X% of nursing homes safe / keeping a given nursing home safe for Y more days]. We can look at those costs and decide they aren’t worth the benefit.
And if you were looking for the most “anti-lockdown” Shelling point where you might get a majority of people to agree, it would be “put a shitload of money into the nursing homes while everyone else is released.”
(And the bans on visitors to nursing homes I read did allow exceptions for events where end-of-life was anticipated.)
How about “there is no statistically meaningful correlation between this policy and improved outcomes.”
If these policies were 90% effective, I’d support them. Reality is much closer to something like “5% effective.”
Don’t put words in my mouth and insist I’m demanding perfection. I’m not. I’m demanding statistically valid correlation. That’s all. Not a super high barrier. And yet…
There are two different situations I think you’re mixing up:
a. People in nursing homes who are no more sick than usual are not able to be visited in person, because those homes are all locked down to avoid getting an outbreak of C19 that kills off half the patients.
b. People in the hospital who are dying of C19 or of other things are not able to have family there/be visited in person, because of hospital policies during the C19 outbreak.
When someone is unable to be with their dying mother, it’s almost certainly (b) instead of (a) we’re talking about–their mom is in the hospital with C19 and the hospital won’t allow anyone except medical personnel in the room with the C19 patients (or maybe just won’t allow anyone but the patient in the hospital at all) because they’re trying really hard not to have the virus spread further.
When someone is unable to visit their mother in the nursing home and she and they are sad because Zoom calls aren’t the same, that’s (a). Those are very different situations.
I’ve seen studies investigating what happened in Japan when they switched from giving flu vaccines to schoolchildren to giving flu vaccines to senior citizens. It turns out that vaccinating children protected senior citizens more than vaccinating the senior citizens themselves.
It’s quite possible that schoolchildren aren’t an important vector for covid. But it does seem that in many cases, you get better protection for vulnerable populations by focusing on the vectors rather than focusing on the vulnerable population itself. (Of course you have to do a cost-benefit analysis of the costs of focusing on either population.)
Deliberately exposing children and keeping them isolated for 2 weeks sounds better and better.
I’m not sure how many people like the idea of “the government will come and take your kids away from you for two weeks and get them all sick, but it’ll be ok, since you’ll get them back afterwards”.
But there’s probably a more humane way of doing this. (I do think some amount of deliberate exposure of low risk people is likely to be a good part of our response in coming months, but we have to see how the first wave of infections develops as the lockdown measures ease up.)
lol I “hit the gun stores” don’t like it.
Yeah, if you try to give my kids back, there’s gonna be a fight!
heh. 😉
Suppose the government does it as an offer, not a demand. Set up free summer camps at which kids get infected and are then taken care of until they recover, thus getting (we hope) lifetime immunity.
What percentage of parents would choose to send their kids?
I don’t have a good enough feel for the average American parent to answer that (or even know which mathematical average I’d want to know!).
For myself, it really depends. I would consider it in the case that we know for sure that Covid will be a permanent or regular fact of life going forward, and that such exposure would make them both immune and not carriers. I expect my children to be fairly terrified being keep in a impromptu camp away from everyone they know for two weeks, and I also expect at least some measure of colossal screw up at various points.
Honestly, even if we only get the parents of 10% of kids to take the offer, that’s great. We’ve (probably) bought a cheap immunity early in the process. Those kids would stop being vectors in the future.
I have some doubts about how it works at ground-level. You can’t let the kids self-govern like Lord of the Flies. You need adult supervision and kicking kids out seems antithetical to the arrangement. Do we have enough workers who have already gone through coronavirus (that we wouldn’t rather put on nursing home duty) to make it work?
I’ve seen some proposals that a decent hypothetical strategy would be to isolate the caregivers and residents – set up trailers or other housing on site, raise the caregivers salary, and then isolate the whole group for some period. (You could rotate caregivers by giving them tests on the way in and/or quarantining them for a period at the beginning of their rotation, and I guess you’d just have to put a mask on the plumber and not let anyone get near where she was working).
It’s hard to imagine that solution actually occurring, but it probably could have saved a lot of lives.
I believe this was tried somewhere (though the country escapes me at the moment) and didn’t work too well. The problem is it only takes one person getting infected to torch the whole place.
Additionally, (NY’s egregious errors aside), I believe “isolate the most vulnerable” was part of most existing strategies for dealing with COVID-19.
In general I agree, but one problem with extrapolating from the current data is that we don’t really know how many deaths the lockdown prevented among old non nursing home residents. Funerals and churches are just two places where sickly, old people could get infected very easily.
On the other hand, protecting nursing homes is difficult and most countries have still done a terrible job in even trying to do so. PPE and tests were usually directed towards hospitals instead of nursing homes (I presume in large part because the former is higher status than the other).
Scott, you’re making the case for the Latin Mass – lots of silent prayer, minimal communal singing, no funny stuff like holding hands during the Lord’s Prayer. (Potential issue: communion on the tongue)
For those of you wondering about enforcement of the lockdown and how it could be done or if it can be done, Italian mayors are not messing around (threatening to send police with flamethrowers round?) 😀
–“I find this answer pretty unsatisfying, so maybe I’m just misunderstanding what the cell phone tracking data are trying to show, or how much I should expect from them.”–
It depends on what we’re measuring by ‘leaving home’. I’ve probably left my house more days than not since mid-March, but that’s mostly to walk the dog, take a drive around for the sake of driving around, that sort of thing. However, close interactions with other people are down ~98%.
I do hope, sincerely, that nobody is really waiting for the government to tell them when it’s ok to hug their boyfriend.
I’d guess these people are hyper-scrupulous and are waiting for a vaccine before they leave the house. I feel sorry for them.
Well feck it, I finally know what my place in the world is. I appear to be supremely suited to “pandemic lockdowns” as no boyfriends, friends, social life or any desire to step outside the house or interact with people. No hugging, touching, or talking in person needed or wanted. I’m even reluctant to go back to work from the working from home.
It genuinely has not been a hardship for me, I feel sorry for all you normal people suffering from “I can’t go outside” but now in The Days Of The Apocalypse, it’s the time when the mutants and freaks have their day in the sun! (Staying sensibly inside, of course, not venturing outdoors) 😀
Oh, I meant I feel sorry for the scrupulosity, not the staying at home.
I’ve been pretty well prepared due to hardly going out even in normal times. But I really do miss not being able to go out and play Magic, and I still get lonely sometimes.
Ironically, the lockdown has given me a far greater appreciation for all the things I can’t do, even if I wouldn’t have done them before. I’ll probably be going out to restaurants *more* after all this is done, at least until the novelty wears off again.
Per Scott’s firsthand observations, and numerous examples I have seen recounted in the media, your hopes are dashed.
Probably most of these people would have socially distanced themselves from their boyfriends/girlfriends/etc to some extent anyway. But with governments fairly explicitly saying that it is forbidden to hug any boyfriend you weren’t already living with, the two likely Schelling points for resuming the hugging are “the government announces it is OK” and “I no longer perceive the government and its laws to be legitimate”.
>But with governments fairly explicitly saying that it is forbidden to hug any boyfriend you weren’t already living with…
This is not correct. I’m not going to google all 50 states, but there was no prohibition on gatherings of <10 people in many states; in fact traveling to care for friends or family members is specifically allowed in the stay at home orders I'm familiar with.
People who are avoiding contact with even one person are going far, far beyond legal requirements.
While it’s true that there have been no official “no hugging your boyfriend” orders as such, I do think plenty of governments and government-supported-official-organizations have promulgated “guidance” that includes stuff like “avoid all non-essential human contact.”
And strictly speaking, hugging your boyfriend is non-essential. So anyone who is inclined to say “I will do everything the CDC says I should do” will need the CDC to come out and say “non-essential social interactions are OK again” before they will hug their boyfriends.
Do you really think those people would relax if the CDC said to? I think some people (thinking of stuff I’ve read on LessWrong) are so risk-averse and hyper-scrupulous that they will be social distancing months after all shut-down orders or even suggestions have been lifted. Just as they were social distancing, in some cases, weeks or months before shut down orders existed in the US.
Yes, there are some people who are going to be even more careful than any official agency recommends.
But to my specific example, I have to imagine there are a lot of people saying “I will do what the official agencies say.” Which means that right now, they are avoiding all non-essential human contact. And they will keep doing that until those agencies go back on that recommendation.
I think hugging your boyfriend/friend/parent/sibling is essential for your mental health. I don’t think humans are supposed to live without human touch.
> And strictly speaking, hugging your boyfriend is non-essential.
This is one of the reasons why I strongly oppose “need”-based arguments for banning things. You don’t *need* a car with an engine with more than 40 HP or whatever. No … but almost all of the things which make life worth living aren’t actually needed.
> I don’t think humans are supposed to live without human touch.
As someone who’s hopelessly single … what does that imply?
@Garrett
Even single people have friends who give you a hug, family members you can kiss, etc.
We were discussing *hugging* a boyfriend, not having sex.
The problem is that the state doesn’t care what you think. The rule is “you can do what we deem is essential,” not “you can do whatever you think is essential.”
Now it’s true that, when specifically challenged on it, even the most ardent pro-lockdown areas have said “OK, fine, seeing your boyfriend is essential for mental health reasons.” But not every jurisdiction has been so challenged, and these decrees have hardly been blasted loudly over the public airways.
In a sense you’re seeing something similar to what’s described in Radicalizing the Romanceless, wherein the people who most want to cooperate and obey are the ones who are going to make themselves suffer under the new tyranny, while those who are happy to defect are just going to defect and pay no cost. It’s the hyper-conscientious folks who are going to suffer depression at home while saying to themselves “Well, not seeing my boyfriend isn’t LITERALLY going to kill me, so I guess I better just stay home…” while Henry is still going out there and banging all five of his ex-wives.
A well designed system rewards the cooperator and punishes the defector. But, as per usual, what we actually have is a system that does the opposite.
I go farther than that. I think the word “need” should be banished from the vocabulary of political discourse.
The implication of the way it is used is that some things are not only valuable but infinitely valuable relative to other things (“wants”), a lexicographic order. That doesn’t describe actual human values as revealed in human behavior. All of us routinely trade tiny chances of getting killed for other things we value.
@ana53294
“Even single people have friends who give you a hug, family members you can kiss, etc.”
That’s rather dismissive of the people for which this is not true (especially in the lockdown).
Have you considered how it looks to such people for you to say “Not only am I privileged enough to have someone like that, but I am going to treat hugging them as ‘essential’, even if it gets people killed.”?
You will please note that I did not say “literally all governments”. And good for you that you live someplace with one of the less-stupid ones.
I, along with about forty million other people, live in the State of California. The government of the State of California has, per Governor Newsom’s order, literally barred anyone from ever leaving their homes except for “essential purposes”, and its definition of “essential” does not include anything that could be construed as allowing social visits to even a single close friend or family member. This has not been altered by any subsequent update I know of. And even when outside the home for “essential purposes”, social distancing must be maintained at all times.
The Government of the State of California, at very least, has explicitly barred people from hugging boyfriends they don’t already live with. At best, you can arrange to walk around the block with them, so long as you stay six feet apart at all times. This is the law, and I’m guessing California isn’t the only state in which it is the law.
That the law is not broadly enforceable, is hardly an improvement. And your “this is not correct” arrogance, is needlessly annoying.
Can you imagine what would have to be in place for this to be enforceable in some significant measure? Definitely worse.
Forgive my “this is not correct” arrogance, but both of those commas are needlessly annoying.
Yeah, California is an extreme outlier. I’m sorry you have to deal with that government.
Edit: I concede I was wrong about this. MOST governments don’t ban small social gatherings, but some do, and man, California is crazier than I thought. Still completely unenforceable though.
@gleamingecho The first comma provides the useful purpose of setting off a clause that serves as the subject of a verb. It could be reworded without a comma as “It is hardly an improvement that the law is not broadly enforceable” or “The fact that the law is not broadly enforceable is hardly an improvement”, but simply saying “That the law is not broadly enforceable is hardly an improvement.” would be needlessly confusing.
@caryatis I don’t think this is crazy. If you hug your SO, and your SO has a roommate, and their roommate hugs *their* SO, and that SO has a roommate, then pretty soon you might as well not have a lockdown. If hugging your SO doesn’t significantly increase the number of people you’re connected to through close personal contact, then yeah, it’s reasonable to do it, but that’s difficult to present as a policy.
Washington state: https://coronavirus.wa.gov/what-you-need-know/whats-open-and-closed
SF bay (https://sf.gov/sites/default/files/2020-05/Stay%20Safe%20at%20Home%20Health%20Officer%20Order%20FAQs%20Rev%205.18.2020.pdf) says:
People who are having contact with any person in these jurisdictions are breaking the law, which SF makes sure to mention in their order. FWIW, I’d guess that the friend lives in SF.
And that’s one of the biggest issues with discussions about this topic – orders and regulations are so patchwork, state by state, city by city that it’s hard to understand what facts people are using to make their arguments – criticism of unnecessary, overly broad executive orders with no end in sight get mixed in with criticism of reasonable orders (of course bars should close! Of course you shouldn’t have a 25 person birthday party in your basement). Nuance is hard – It’s a lot easier to point and laugh at the large group protesting with guns and proudly announce your support for saving grandparent’s lives while ignoring the text of the order.
California hasn’t really talked about this, which is part of my complaint, but a lot of governments have said this. See eg this article from Australia: https://thenewdaily.com.au/news/national/2020/04/01/dating-relationships-coronavirus/
You’ve forgot the most common one – our case is special, and I can hug this boyfriend, because we’ve been doing everything else right/we’re not in a high risk group/we’re both taking vitamin D/it’s been 2 weeks since we’ve done anythign really dangerous and hence can’t possibly have CV-19.
Anyone willing to take that option has already taken it by now.
The term “Schelling point” refers to a policy arrived at through many levels of recursive modeling of others. I don’t think it really applies here.
Unfortunately, in my Bay Area circles, this category of thing is a live question. Not just hugging one’s significant others (of course this is an especially fraught question for poly people), but letting one’s kids have playdates with the neighbor’s kids, inviting said neighbors over for a drink/dinner, etc. People don’t want to be seen as the irresponsible ones, and especially don’t want the guilt/opprobrium of being a transmission vector if it feels like it was “their fault”.
So far I’ve been promulgating the following rough heuristics:
— If your kids are going to an out-of-house group childcare, you probably shouldn’t worry about occasional small social gatherings.
— If we reach “Phase 3” where hair salons and gyms can reopen, the general level of risk implicitly countenanced probably includes occasional small social gatherings.
But I’d be curious to know how similarly-situated others are thinking about it. Eschewing all in-person, share-food-and-hug type encounters with friends until a vaccine is available seems crazy, but as Scott says I doubt we’ll get less-strict official guidance than that.
There are harm reductions that can be put in place, right, in between “never see your friends” and full normal. Smaller gatherings, outside gatherings, standing further apart, more handwashing. Maybe wear a mask to your party (although would make it harder to eat or drink).
I think it’s also relevant to consider that it’s not just the number of contacts you have, but the set of people with whom you have them. If the set of people that are interacting is large, but closed, then the community can be treated as a unit, and has no effect on spread outside the community. But if you each have occasional contacts outside the set, then you really want this set with sustained contact to be small, both to minimize your set’s contribution to community spread, and to keep low the set of potential vectors into your community.
Most orders seem to distinguish at the household level, but it seems perfectly responsible for some people to designate two or three households as a single unit, as long as all the people in all those households are extra scrupulous about further outside contacts.
So you want your kids to be going to the same childcare with the same set of kids, rather than different childcare every week. And if they’re going to have playdates, it should be with the kids from the same childcare. And if you’ve got a big polycule, then you may want to have some temporary firewalls within it, even if you don’t put one at the boundary of every single residential household.
Doesn’t work if anyone in the unit does their grocery shopping in person.
Going grocery shopping once a week is *way* less exposure than having your kids and their kids play together for a couple hours every day and having each other over for dinner a couple times a week. Also much less exposure than the single guy and his girlfriend getting together for sex a few times a week.
Less exposure to what? If they don’t have it, you can neck all day long without consequences beyond the chiropractic.
The problem with grocery shopping is not the proximity, but the mix of people from all over town, including people who might not feel good enough to do anything else but need to eat.
The best model I know for trasnmission is that it depends on distance, time, and activity. If you’re doing things that make a lot of respiratory droplets, if you’re very close, and if you spend a lot of time in that situation, your chance of transmission goes way up. Under normal circumstances with no social distancing, an average person with C19 seems to infect 2-3 people during his contagious period, but an average person pre-lockdown has casual contact with dozens of people and close contact with many people every day.
If your girlfriend has C19 and you sleep with her, you’re almost certainly going to also get it. If your neighbor’s kid has C19 and your kids play with him indoors all day, there’s a pretty good chance one of your kids will catch it. That’s driven by lots of time in close proximity, being indoors where any droplet nuclei can accumulate to high concentrations, etc. There are *tons* of opportunities for virus particles to make their way from your girlfriend’s respiratory tract to yours, or from your neighbor’s kid’s respiratory tract to your kid’s, over many hours together.
If the cashier has C19 and you buy groceries from her, you have a chance of getting it, but that chance is probably pretty small. You’re within a couple meters of her for maybe 5 minutes tops, and unless your grocery store is a lot friendlier than mine, she’s not going to spend a lot of time passionately kissing you on your way out, or doing moderate exercise while your faces are six inches apart. Similarly, she and you aren’t going to spend hours sitting next to each other building things out of legos or climbing around in the same indoor fort. So the probability that the cashier transmits C19 to you is just a whole lot lower than the probability that your girlfriend or the neighbor’s kid transmit it.
Yes, if (a big if) there is a problem with grocery shopping its standing in front of a cashier who stands in front of a few hundred people a day.
Only once you assume that the person has it. However actual transmission is that aggregated for every individual you come in contact with times the likelihood that one of them gets sick. Sex with your sick girlfriend is way more likely to transmit than a sick cashier at the grocery store, but that isn’t the whole thing.
I think this conversation is in the context of assuming your partner or friend is otherwise being strict about social distancing and following quarantine.
If the choice is between high exposure to a single careful individual showing no signs, or casual contact with a large group of unknown people, I think the former is safer.
Certainly, intimate contact means you both basically sum your risks, but if one or both of those is basically zero, then you aren’t increasing the spread.
Sure. Imagine some interaction between Alice and Bob.
P(Alice catches it) = P(Bob has is) * P(transmission | their interaction)
Some interactions have a very high P. For example, if you live in the same home, P(transmission) is probably pretty close to 1. Other interactions have a very low P. For example, if you go to the grocery store and walk by 20 people in the aisles, plus interact with one cashier, then your interactions with those 20 people each have a very low probability of transmitting anything even if one of them has the virus. Your interaction with the cashier is higher but still much lower than 1.
This is a consequence of R_0 being between 2 and 3 and the contagious period being around 10 days. Without any social distancing, an average person probably interacts with more than 20 strangers as closely as you do with the strangers in the store each day, and with maybe another 5-10 people as closely as you do with the cashier. Yet, over ten days that average person manages to infect two or three people. The probability that any one of those interactions will transmit the infection must be really low for that to be true.
This.
New Brunswick (Canadian province) or possibly the specific municipality my sister lives in, has explicitly allowed its residents to form a “monogamous” relationship between households, such that 2 count as one for purposes of isolation. Sometimes it’s neighbours with kids sharing childcare (and thus giving each other time away from child management responsibilities); sometimes it’s vulnerable person (grandma) and caretakers (adult child not living with her); but it can be whatever they want.
Folks in other jurisdictions are obviously doing similar things informally, but I’m impressed with New Brunswick for making it explicit, and thus making it clear that it’s not the same thing as having contacts with a dozen households, who each have contact wiith their own dozen.
“If your kids are going to an out-of-house group childcare, you probably shouldn’t worry about occasional small social gatherings.”
It seems to me that having group childcare should make you worry *more* about small social gatherings. Is this “in for a penny, in for a pound” type reasoning?
One reading of it is “if the risk of contagion is low enough so it is safe for your kids to go to group childcare, it is probably also low enough so that occasional small social gatherings are safe.”
What your kids are doing is evidence of how low you think the risk of contagion is.
It seems like, even if you don’t live together, visiting a significant other but otherwise limiting your outside contact might even be MORE effective than each of you hunkering down separately.
If the two of you share most of your outside trips (e.g. go to the grocery store together for your weekly shopping) you effectively become a single unit as far as an infection vector – you are contacting the same people, in the same places, at the same time.
Whereas if you stay apart, you’re going to have ~twice as many encounters with strangers during your essential trips.
One aspect of governmental response I don’t see discussed here that I think did have a big impact: forcing nursing homes to accept back COVID patients. Both NY and Pennsylvania did this.
It sounds like madness to me, ordering the whole state to isolate, and then essentially ordering the opposite for the populations most at risk. 69% of Pennsylvania deaths so far are associated with nursing homes.
Also, New York was probably always going to get hit big, but the continued delay and delay in closing down vectors probably doubled the number of deaths they had:
https://www.propublica.org/article/two-coasts-one-virus-how-new-york-suffered-nearly-10-times-the-number-of-deaths-as-california
There was a lot that government policy couldn’t do, but that doesn’t mean that there wasn’t also a lot that government policy could do.
From what I hear, the UK (or perhaps only England) also did this.
Anti-patterns like this make the conspiracy-theory-vulnerable part of my mind start suggesting conscious attempts to cut costs – on medicare, social security, etc. – by reducing the population eligible to receive them.
[Note: In software engineering, an “anti-pattern” is a bad design that occurs frequently, sometimes because people imitate existing bad code or follow outdated advice, and sometimes because they just tend to reinvent the same square wheel.]
I could imagine the logic when they first did it. They are worried that nursing homes would dump covid-positive patients onto someone else or make them homeless. There are a lot of reasonable mistakes people made thinking only 1 step ahead.
But as other people adopt better policies and people keep on screaming at you how yours are getting people killed it becomes time to change. Pennsylvania’s public health director taking their own mother out of a nursing home and into a hotel sure looks murderous, too.
Anecdotally, I heard that Medicare is paying nursing homes something like $800 per day to keep Medicare-eligible COVID patients.
If true, the perverse incentives are . . . interesting.
Add Minnesota to the wall of shame. 80% of their deaths are in nursing homes.
That’s not necessarily a great metric. New York has among the lowest “percent of deaths in nursing homes” because they have had so many deaths outside of nursing homes.
Your link regarding the NY policy says
““And the regulation is common sense: if you can’t provide adequate care, you can’t have the patient in your facility and that’s your basic fiduciary obligation — I would say, ethical obligation — and it’s also your legal obligation.”
Cuomo said that if a nursing home can’t properly quarantine and treat COVID-19 patients with separate staffers, it’s required to move them to another facility or ask the state Department of Health to arrange a transfer.”
That’s really confusing to me. It sounds like they *are* allowed to refuse COVID patients.
I live in Tokyo – I’d attribute the Japan vs the rest of the world miracle to mask wearing. It’s also one major thing they have in common with South Korea. Government shutdown or no government shutdown (it was actually a state of emergency declaration, notably there was never actually a ‘shutdown’ due to strict constitutional limits on government powers), the vast majority of people were already wearing masks all winter because it’s just what you do. And in the last couple of months it’s been incredible, it’s very hard to find someone out on the streets without a mask – I’d put the non-mask-wearing rate at lower than 1%.
I hope you’re right– since if you are that says that widespread mask wearing in other developed-world metros should suffice to keep a lid on things.
I am skeptical. Mask wearing is high at exactly those places where people do not catch the virus easy anyway: The streets, public transport etc. The nasty places with lots of talking and sustained contact like restaurants or cramped offices are still open. Have Japanese people transitioned to wearing masks at work too?
I’m surprised you didn’t show FiveThirtyEight’s data showing that people started staying home at the same time throughout the US, regardless of when their governor issued a stay-at-home order:
https://fivethirtyeight.com/features/americans-didnt-wait-for-their-governors-to-tell-them-to-stay-home-because-of-covid-19
There are people who are estimating Rt directly:
https://rt.live/
Although the error bars are large, most of the country appears to be under 1 [glares at Minnesota and Maine] and reopening hasn’t led to an increase in Rt.
One possible explanation for why R seems to be so close to 1 currently is that the number of cases is falling, but the testing rate is increasing, so we’re confirming a larger fraction of the cases. This data seems to support this:
https://covid19.healthdata.org/united-states-of-america
On the first point – I thought the graphs very clearly showed a decrease in leaving the home around March 15 in every geography!
I’m surprised to see an estimate of Rt that is below 1 for Texas. Just looking at the cases in my own county, there’s been a very notable increase in the rate of infection during the month of May. Starting about a week after the shutdown order on March 24, cases slowed down to just about 1-5 per day, but in the 15 days since May 3 we’ve had another 120 cases.
http://www.brazoshealth.org/sites/default/files/inline-files/5.18.20.pdf
But if Houston and Dallas have kept their rates down, then all the smaller counties increasing isn’t going to show up right on this statewide chart.
I don’t know how they’re calculating Rt. They do have a link to their code at the bottom, but I haven’t parsed it.
Rt is related to the second derivative of the number of active cases (or the first derivative of the number of new cases). Eyeballing your county’s data, I would say Rt > 1 before 3/31, then Rt 1 until 5/8, then Rt < 1 (barely) since.
The website does have the option to overlay the number of new cases. Texas's new cases are increasing pretty consistently throughout the time frame, so I'm not sure how they've gotten Rt < 1.
I don't know how they're dealing with the time delay between infection and detection, or if they're estimating the difference between actual cases and confirmed cases.
I’ve become significantly less convinced of their numbers for Rt. As new data comes in, they revise their past estimates. These revisions are sometimes noticeably larger than the error bars shown.
Their estimate for Texas now has a Rt > 1 through the beginning of May.
Why is R_t of any significance? Sure, it’s *related* to numbers that matter, such as doubling time, etc., but why track R_t rather than those numbers? R_0 at least is useful because it gives you an idea what the herd immunity requirement is.
R_t is the most significant number in determining the long-term dynamics of the disease. If R_t is less than 1, then the disease will eventually die out. As long as R_t is greater than 1, the disease will not be eradicated and any initial outbreak will spread.
I’m very afraid of this, because I think it is very likely. Even if we let up on legal restrictions, the authorities seem resistant to doing anything to puncture the fantasies that this will all clear up relatively soon. So a lot of people will still behave as though this is the case, and end up even worse off. Even things like professional sports–people won’t go if they think it will come back next year, and there will be social pressure not to allow such frivolous mass events because of fantasies of containment. A bunch of people lose one of their favorite things or their jobs as a result of that industry collapsing. If people realize this is just the way it is going to be, to some will still stay away, but many more will shift their expectations about risk because they have no choice. I’m not claiming there would not still be serious risks and fears, but if we’re just delaying the inevitable, it doesn’t really matter. There are situations most people would never voluntarily choose, but if all other situations are basically impossible, that will be the one they’re stuck with. It doesn’t matter whether we find it acceptable. But as long as there is the illusion of a miraculous escape, the needed adjustments, whatever they may be for each person, won’t be made, and the same goes for larger social and economic reorganizations. In the meantime, the wasted adjustment/practical long-term mitigation time and energy is massive. If people think global tourism has a good chance at a comeback next year, the people who work for that industry won’t look for new jobs, nor will the government come up with a plan to assist them. We’ll spend tons of time and resources propping up things that are simply untenable.
The leaders of South Korea, Singapore, and New Zealand are telling their people there will be no quick return to the status quo, and that the economies are taking a huge hit and will continue to do so for the foreseeable future, largely due to the restrictions on air travel. Lots of Americans are under the impression that those countries have mostly fixed the issue and we just need to do a better job copying them so we get back to the status quo. It’s really messed up to laud the leadership of these people while misrepresenting them in service of a false ideal. I know people want to think there’s an easy fix, but we need to prepare for reality just like the citizens of those countries. Psychological preparation is important.
I feel like we’re disastrously trying to create the illusion of control and making things worse, when we could be intelligently dealing with what is actually in our control. While of course I’d love for a miracle to happen, I expect that it will spread until we (hopefully) achieve herd immunity, and that it will never totally evaporate. I’ve never been able to see anything else as realistic. But the few who agree with me on that tend to add, “exactly, it’s no big deal, in a year it’ll be back to normal.” That is also wrong.
The silica gel packet line gave me a much-needed laugh. Some great lines and information in this post.
Indeed. This has been my primary reason for opposing lockdowns from the start. Because I fear the worst case scenario. And contrary to what the media is saying, I do not view “We sacrifice millions to die of COVID in order to save the economy” as the worst case scenario. On the contrary, the true worst-case scenario is “we intentionally agree to large-scale economic devastation and significant decreases in quality of life for everyone in the world… and millions die of COVID anyway.”
Preach it, Matt.
This is the worst-case potential downside of the lockdowns–we all get C19, just a few months later when we’re all poorer and sadder and paler from the lockdown.
Being aware of this as a possibility really ought to make those of us who support lockdowns and other measures be thinking in terms of how to minimize the damage done by whatever anti-C19-spreading measures we enact. That kind of thinking plays poorly with the moral-panic mode of thought, however….
Worst-case scenario is a lot worse than that. What was the worst case scenario of the Treaty of Versailles destroying Germany’s economy?
edit: I think we are on a clear path toward world war three with China. All over the world people are angry at China and when the real economic pain drags on for a year plus, that anger will turn to rage.
In addition to that, the lockdowns have given carte blanche for repressive governments around the world to get way more repressive, so we could see some human misery and death on that end as well.
And in addition, spending all our warchest on COVID may mean that we are genuinely screwed if another natural disaster hits in the next couple years, and states start to collapse.
What about “we try to continue business as usual as much as possible but 10% of the population gets sick at the same time and the economy goes to hell anyway”?
Why would the economy go to hell with 10% of the population getting sick?
“10% of the population gets sick at the same time” isn’t that crazy of an outcome. New York City’s ~25% percent infected over a couple months means they got within a factor of 2-3 of that, while under lockdowns.
Also it’s pretty clear getting 10% of the population to not be able to work isn’t apocalyptic, as that’s basically the increase in the number of unemployed people we ended up getting. At least with 10% sick most of them would be back to work after a couple of weeks.
I’m not sure that’s how it would play out, but as it is speculation I won’t argue the point. One of my main points is this:
The way in which it goes to hell under such circumstances is different than the way it subtly goes to hell while we preserve the fantasy of a quick return to the status quo. It would be a more “natural” or “intuitive” collapse, in that we’d be able to see what was going on and react accordingly, and also that we’d now be in agreement as to the seriousness and able to move in a more coordinated yet flexible manner and make more realistic choices and adjustments. It would also be over more quickly, allowing a faster acceptance and rebuild process and perhaps some level of herd immunity. (I realize that hospital overload would be an issue here, but I’m not convinced the numbers would be higher in the end.) Emotionally, I actually think many people have a harder time with the chronic worry and uncertainty and dragged out process of intentionally spread out deaths than they do with a mass casualty event. While I am in no way trying to argue that either of these situations is easy or “preferable” in a meaningful sense, I think it is a mistake to assume people react proportionally to the amount of death at a given time. Circumstances and expectations matter a lot more. This can’t be managed from the top down through purely logical calculations–societal and economic systems are too complex.
It’s not even just the worst case being a ruined economy/social structure and the deaths—-there are degrees and forms of ruination that get worse with time and denial. The lockdown itself tends to have the practical effect of enabling the denial to continue, preventing necessary adjustments, which is one of my biggest concerns.
If it was going to be 10%, we’d probably be fine. The concern is that it’s 90% if we ignore it and everyone gets it at once, resulting in a CFR of 3-5% for lack of available care.
It probably wouldn’t be that bad, but yeah, that is a concern. I think hospital overloads will probably be a thing, but people will become cautious if that starts happening, and at least put the breaks on a little. I know it will have a delayed effect, but I don’t think it is likely to spread to literally everyone at once. Some people are immune. Some will practice pretty good social distancing and wear masks, some will stay quite isolated, many of them being the highest risk who would overwhelm the hospitals. Some will die at home or have DNRs. Most won’t be hospitalized. It won’t be geographically uniform. So depending on the demographics, things could just play out a lot differently. I wouldn’t advise letting it run totally wild, but I think it can be mitigated. No, not perfectly, but nothing about this can be done perfectly. I’d be most worried about running out of palliative care drugs (which overlap with ventilator sedation drugs), but I’m also a little worried about the supply lines holding up over time with the lockdowns. I know some have raised the issue and I hope someone is on it but it seems like people are (understandably) so absorbed with other things that this was going overlooked for a while.
Also, I wouldn’t have been opposed to some staggering lockdowns for a few months–maybe that is the best thing. But the hospitals were not overloaded and the politicians couldn’t bring themselves to permit, let alone condone, greater spread even among the low risk knowing we could handle more cases. I get that it is a weird position to be in, but don’t seem to be able to strike a balance.
90% *too sick to work* *at the same time* sounds pretty much impossible no matter what we did.
The Hong Kong Flu (from wikipedia):
France’s GDP growth per year: https://www.macrotrends.net/countries/FRA/france/gdp-growth-rate
GDP growth from 1968-1970 stayed higher than +4%, and it sounds like COVID has a lot more asymptomatic infections than Hong Kong Flu.
Here in NZ, our prime minister Jacinda Ardern has done a fantastic job during the crisis, particularly with communications. My worry here though is that the Labour government has proposed a massive New Deal style economic recovery package which I think will subsidize a lot of non-productive behavior. They have are also fully entrenched on an eradication strategy so if it becomes a better move to go for herd immunity, it won’t happen without a change in government.
One thing they are doing is free training and subsidized apprenticeships to get people into the trades. I can’t see the democrats in the US supporting the trades over just offering free university, so chalk one up for NZ not being so culturally polarized.
Other things involve ‘environmental’ work, building houses, fixing insulation in houses.
They are forecasting 9.6% unemployment at the worst, and debt ballooning to 53% of GDP (170 billion). I think that our unemployment is going to be much worse than that, and if it isn’t, will only be because people are being paid to do unproductive work. Which means the tax base will shrink and debt could end up a lot higher.
I’m not even close to an economist (so feel free to correct me please) but it seems to me that in the great depression, at least government spending on core functions was a lot lower. But if the government today soaks up a lot more resources, and is a lot harder to shrink, then what happens when the tax base shrinks too fast and unemployment/zombie employment is stuck at a high level?
So your default is that a government order is correct?
Opps, meant to be a reply to Caryatis above.
I suppose my default is that the easiest thing for me will be to follow the law, unless there’s a good reason not to.
>The best answer I can come up with is that most people are risk-averse and started staying at home before the official lockdown. A few risk-tolerant people didn’t, but they are disobeying the lockdown as much as they can anyway.
I think SSC readers are unusually independent-minded and might underestimate the number of people who defer to government recommendations regardless of their personal degree of risk-aversion. In an environment of uncertainty, lockdown orders are a powerful guide to what the right thing to do is, and I personally follow them and plan to go out only after they are lifted—even though I think there is a very good chance those orders are overly cautious and a very low chance that I would get arrested if I disobeyed them.
I would slightly disagree – and suggest that SSC readers are “more internally consistent” than the general public. Which is to say that SSC will include both more people who “say lockdowns are good and don’t violate them” and people who “say lockdowns are bad and violate them.” Whereas, the general public will include a very large amount of people who say lockdowns are good, but find plenty of reasons/excuses why they, themselves, should be allowed to violate them on occasion.
Like, I’d guess that the average American says “lockdowns are necessary and should not be lifted and violators should be punished” but has themselves already violated at least twice.
What struck me a very long time ago was that many people claim to believe that one is morally obliged to obey laws, but most of them feel free to drive somewhat over the speed limit.
I think this lacks nuance. There’s all sorts of people, from e.g. people with extended families living closely together or requiring care that effectively have social circle of 20+ people without violating the rules, to couples in committed relationships that still live apart and break the rules by seeing each other, regardless of how much they limit their outside contacts. You have people living in group homes, which is ok, yet if the same people lived in single apartments, they’d violate the rules even if the designated a single mutual outside contact to meet in person. You have families allowing their children to violate the rules on occasion to stay sane (again, if you have a bunch of kids, they have playmates even under rigorous lockdown, if you have a single child it has make do without other children around.)
And, of course there are those who think the rules don’t apply to them or they’re invulnerable.
But from what I’ve seen they’re the exception and most other rule violations are an attempt to tailor the official rules to one’s specific circumstances. The alternative would be a 100+ page booklet that informs you on page under section 3.4.2.1 that you may see your unmarried partner if you’ve been together for over six months, pool your exposure while shopping and have no other outside contacts, with a fine of X for each month you’re short of the 6 and another fine for shopping independently, which is however waived if you both shop at the same store (as that would be allowed if you lived under one roof).
Of course it lacks nuance. My point is that people are perfectly capable of seeing the nuances in their own circumstances (and occasionally the circumstances of their close friends and family), but not of random strangers.
So if you see a guy on the street not wearing a mask, your first thought is “What an asshole! Doesn’t he know he’s putting my life at risk!” But if you’re ever on the street without a mask, you know it’s because you’re only traveling two blocks and you have asthma which makes breathing difficult for you while wearing a mask.
My point is that if you’re going to uncharitably assume everyone you can see who is technically violating the rules is a bad actor who is defecting and risking the lives of millions for their own personal pleasure, well you damn well better be absolutely never technically violating the rules yourself. You cannot demand perfect compliance from others unless you are willing to exercise it yourself.
I would suggest that the number of people who act regardless of their personal degree of risk-aversion is very, very low. There’s no activity for which you turn your risk-aversion meter off; rather, for that particular activity, your risk-aversion level is 100%.
What are the genetics of Switzerland? I can’t find data about haplogroups online. If the genetics of the Swiss groups resemble those of their linguistic home countries then the differences in infection and death rates might be due to genetics.
Specifically, I’m thinking of a vulnerability of people of Celtic ancestry: this is the common denominator between Northen Italy, France, most of Spain, the UK and Northeastern US. It would explain why Central and Southern Italy have remained relatively unscathed despite geographical and political contiguity with Northen Italy, as Central and Southern Italy are non-Celtic. However it doesn’t explain Ireland (Celtic, not strongly affected) or Catalunia and the Basque country (supposedly non-Celtic, strongly affected).
As someone living in Switzerland, I can say that there is no mystery at all if you live in Switzerland. The lockdown happened simultaneously throughout the country. At this time the Italian-speaking region Ticino was already heavily affected because it is close to the Italian hotspot Lombardy (close in terms of distance and in terms of the number of travellers), and the French speaking part (especially Basel) was stronger affected because it was close to French hotspot Alsace.
I don’t think this data says what you think it says. From my read of that report, it’s tracking the number of people who do not leave home at all. Anyone who goes 150 meters away from where the cellphone spends the night is going to trigger this data point. This means that going on one 30 minute walk a day, or one quick trip to the store would count as much as going to work at the doorknob licking factory for the purposes of this graph.
Frankly, with this consideration, I think it’s shocking that the numbers have decreased at all.
I’m not so shocked that the numbers have decreased some. Anecdotally, I have a friend who says she hasn’t left her apartment in the Upper West Side for 60 days (I guess she gets groceries delivered? And she’s a professor, in her 60s, whose wife manages a choir, so they are both seriously trying to avoid risks.) And while there have been some days in the past couple years where I didn’t leave the house, it’s certainly much more common these days that I get busy with work/computer game and forget to go for a walk than it was even on the work-from-home days in the past.
But these graphs seem to suggest that even at the beginning, on any given day, something like 20% of phones never left the home! Are these all retired people and homemakers? (I sometimes struggle to remember that only 60% of people are employed usually.)
Some of these might be people who use a different phone at work. But staying home one in five days doesn’t seem that outrageous to me. Many people who work outside the home enjoy relaxing at home on the weekend, and some people are unemployed, disabled or simply work from home and only go out for social reasons.
Mobility data of the sort of “how many people are leaving their house”, and on driving or walking, are pretty poor proxy for a level social distancing. Only public transit usage appear to be dangerous activity among aforementioned mobility indicators.
E.g. I personally have a step counter on my smartphone, so I have a good idea on how much I walked during a lockdown, if not for other forms of mobility, and after five weeks I´ve returned to normal prelockdown level of steps being taken, so on that measure it would appear like I am not socially distancing at all. But that is not the case.
In fact I merely stopped being so paranoid about surface contamination outdoors since it became apparent that it is not a major risk factor and I´ve taken conscious effort to take 10 000 steps a day in order to stay in mental and physical shape. I am still very much avoiding close personal interaction and crowded public transit.
The data is actually much better than just “people leaving their house”. For example, Google provides data for each country on how much time people spend at public transit stations.
I am reacting on what is written on curves of those graphs Scott posted above. If they are based on some measurement more sophisticated than their labeling suggests, I take my comment back. Do not have time to investigate it myself.
Can any doctor comment on the flu deaths statistic from the last paragraph? My concern is that confirmed flu deaths might be a bad comparison to confirmed COVID-19 deaths since we might not bother confirming a flu infection. If you get a patient in the ICU with, say, pneumonia, do you bother running a flu test? Do they test after death for flu in case someone dies outside the hospital? I’m not sure I’m even asking the right questions here, but generally how aggressively does one confirm/disconfirm flu in the kinds of patients that could end up dead?
My guess is that neither confirmed flu deaths to confirmed covid deaths nor suspected flu deaths to suspected covid deaths is a totally clean comparison, for all the reasons mentioned throughout. But they give some sort of bounds on your estimates. And importantly, we can compare the flu numbers for last year to the flu numbers for this year, to see how much the measures taken in the last few months have affected flu deaths, and try to extrapolate how they might have affected covid deaths.
I think this is mainly a psychological problem, primarily created by the media (but in their defense, basically giving the public what it wants). You see it come up on other politically-charged debates such as terrorism, and maybe even moreso “murders committed by illegal immigrants.”
People react very differently towards deaths that they see as natural/unavoidable and deaths that they see as caused by human error, or even worse, political policy (or even worse than that, political policy they already opposed anyway).
Like, the primary reason that conservative red-tribe man views “pretty white girl kidnapped by illegal immigrant” as worse than “grandma dies of heart disease” has nothing to do with how old grandma is or how much quality of life she has left or the estimated economic lifetime productivity of the teenage girl or anything else. It’s because he views grandma’s heart disease as “something we can’t do anything about” and immigrant-related crime as “something we could easily prevent if we wanted to” and “something we should probably do anyway even if it wasn’t saving lives” (because it would let Americans keep their jobs or whatever).
So what’s going on with COVID today? It seems to me that the issue is that we’ve reached some sort of state of… I don’t know if I want to go as far as to call it “civilizational hubris” but that’s what’s coming to mind. We believe that we (or more specifically, the state, or perhaps “the experts” have achieved something close to the status of Gods). We believe that all deaths are preventable, and that, therefore, any deaths that happen, happen due to a lack of political action. And there’s a non-trivial portion of the population that thinks “consolidate state power, print tons of money, institute something roughly approximating a poorly-designed UBI program, shut down the churches, make people beg permission to host parties, etc.” are good political actions that we definitely should have already done anyway (even if it didn’t save COVID lives).
But I don’t think our scientism/hubris/whatever you want to call it has started looking back yet. We see COVID as preventable because it’s new, and it confirms our priors about human mastery over nature and state power. But we haven’t gone back to correct our priors about heart disease, or cancer, or anything else (not even seasonal flu for that matter). So COVID is still getting placed in the “things we could prevent through political action” bucket with the Vietnam war, 9/11, and immigrant-crime; while heart disease, cancer, drug overdoses, and car accidents are still seen as “natural things that just sort of happen and it sucks but what can you do?”
I don’t think you need scientism to explain it, just hedonic adaptation; and nor do you need a belief that all deaths are preventable, just infectious-disease ones in particular. People before 1950 or so took significant risks of death and morbidity from a multitude of infectious diseases as just part of life, and went out and mass-gathered anyway. Then vaccines came along courtesy of Salk, Hillerman etc and our baseline risk of that type of mortality dropped precipitously. Now we’re used to not having that category of risk in our lives, so reintroducing it seems terrifying even if it’s no worse than what our great-grandparents shrugged at.
I don’t think that’s so far off from what I’m saying here.
Our modern medical advances, to include vaccines and the like, have caused us to believe that we have conquered infectious disease, such that any further deaths from it are intolerable and must be viewed as political choices rather than unavoidable tragedy.
But this is not actually true. We have overestimated our capability in this regard. And this overestimation is causing us to make very poor decisions in terms of overall cost/benefit. On both ends, actually. Because we’re also over-estimating our ability to manually intervene in the economy without causing long-term negative and unforeseen consequences.
Yes, exactly this. In many ways, what’s going on is straightforward and easy to understand, but it is also a gigantic mistake in reasoning. Infectious disease risk was never something our medical and social advances put to rest—it just looked that way because we had so much success with the common ones for a while. And we’re categorizing things incorrectly, as you explained, due to psychology + media/political environment. We’re very confused about what’s actually in our control, on both ends, and that is dangerous.
I think this is a great point. The fact that people are dying is taken as evidence that our leaders have failed, or not tried hard enough. Because if we truly wanted to stop people dying, and truly tried hard, we would succeed, right?
I find myself thinking of Epictetus often lately: know what you can control, and what you cannot control.
A quibble. I think this is baked into our psychology. The media ain’t got nothin to do with it. I think you’re right that the media is giving the people what they want, but I don’t think it’s a media creation.
Right. Sorry if I was unclear, but this is what I was trying to say. The media is perpetuating the meme, but the only reason they’re doing so is because we want them to. The media screaming that Trump is personally responsible for every COVID death only works because society in general believes that sort of logic is valid and makes sense (even if for partisan reasons, they shout back “actually it’s CUOMO, not Trump… or Xi, not Trump” who is responsible!
But the general theme of “these deaths could have been prevented through sufficient political action (unlike your normal routine deaths from cancer, heart disease, suicide, etc.)” is accepted by like 95% of the population.
@ Matt M
I agree with everything you said in your OP.
Still, what makes Covid different from any of those things was that, at one point, maybe in early-mid January, Covid may have been containable using political action alone (and maybe Chinese political action alone at that). Problem is, it’s four months later and we have a global pandemic on our hands. It has exposed how much of the epidemiological playbook is based off of early detection and containment — and that once the horse is out of the proverbial barn it is nigh-impossible to reel back in.
The degree to which the horse can be put back in the barn depends on the rate of spread, incubation period, prevalence of asymptomatic carriers, etc. Covid is unusually bad in ways that make it much harder to contain (compare to SARS and MERS).
At least we aren’t dealing with Super Measles, I guess.
But I don’t think the average person understands/believes this. At all.
If they did, common opinion would be “It sucks that we didn’t take the action when it might have helped, but since it won’t help now, we shouldn’t have lockdowns.” Instead, public opinion is “We need to have the lockdowns so people won’t die.” Public opinion (reflective of what the media is reporting) is that, even today, we can control and defeat the virus through political action, and that doing so will, in fact, be worth the economic cost.
This assumes a lot. In particular that a generalized lockdown is the only policy lever at our disposal, and it’s boolean.
If deaths were a random subset of infections, then this would be maybe reasonable, but the risk factors are stark. Hospitalizations are highly age stratified. Furthermore, lockdown has been effective at reducing hospitalisation in the 65+ set, but had almost no effect on the under 40 crowd (modest effect on the 40-65 group).
https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html
Within the hospitalized population, ~90% have at least one identified underlying medical condition.
https://gis.cdc.gov/grasp/COVIDNet/COVID19_5.html
I just read a report yesterday that 80% of all covid deaths in Canada are attributable to infection spread in retirement homes. Meanwhile, NYC is sending known covid positive patients TO retirement communities.
Why are we doing such an especially bad job of protecting the most vulnerable populations, while expending a lot of money and bankrupting a lot of businesses making sure healthy college kids can’t get haircuts? There has to be a middle ground where we encase the old and vulnerable in bubble wrap, and let everyone else build herd immunity around them.
Also, while covid ranting, I’m not Anti-vaccine in general, and get a flu shot every year, but spending hundreds of billions of dollars researching a covid vaccine seems like a really bad ROI. It’s probably only effective for 1 season. Let’s spend hundreds of billions of dollars researching better treatments for pneumonia instead. It’s how covid actually kills people, and by the way, a boatload of other respiratory diseases lile sars and mers, and the seasonal flu…. and very likely the next pandemic. Plus, it would be highly mutation agnostic so we wouldn’t need to reinvent it every year. Plus, rather than having to administer it to everyone, in advance, it only is given to people who need it at the moment they need it, so scaling the production pipeline is far more manageable. It just seems like a way better strategy all around and haven’t heard any serious discussion about it.
counting such “medical conditions” as obesity or hypertension. How much of the general population doesn’t have at least one of those?
Yes. I don’t think this argument is running the direction you think it is though. The fact that the hospitalisation rate is so low for most age groups despite the high prevalence of the highest risk conditions like obesity and hypertension, would seems to point to the vulnerable group not being ‘old OR has a medical condition’ but rather ‘old AND has a medical condition’. Though admittedly from the CDC website I couldn’t find a way to get the condition per age group data to validate that interpretation.
From what I’ve seen, it’s sort of both. Being old is a significant risk (regardless of other conditions) and having other conditions is a risk, albeit a lesser one (regardless of age).
Think of it like a 2×2. “Old and other conditions” = high risk. “Young and no other conditions” = virtually no risk. “Old but otherwise totally healthy” = moderate risk. “Young but some conditions” = low/moderate risk.
Pneumonia in Covid 19 cases isn’t anything like pneumonia caused by the seasonal flu. Pneumonia from the flu is usually a secondary bacterial infection. Pneumonia from Covid 19 is an immune system overreaction caused by the damage inflicted by the virus itself. I do agree that treatments to stop the immune system overreaction and to halt viral replication would be better bets.
A couple of corrections:
The linked article is by Lee Drutman (who has written several articles for FiveThirtyEight but is not listed on their masthead) not by Nate Silver (FiveThirtyEight’s Editor in Chief)
The linked article estimates the cost of a lockdown as ~$2.86 trillion, not $5 trillion.
(It doesn’t list the cost of a lockdown directly, but says that lockdown + coronavirus reduces economic activity by “22%—a cost of $4.2 trillion” and that coronavirus without lockdown would reduce economic activity by 7% (~$1.34 trillion). Subtraction shows that lockdown adds ~$2.86 trillion, not %5 trillion.)
Thank you for posting this! I find it baffling when folks conduct analysis of the cost of the lockdowns while ignoring the cost of the virus itself. It’s not like people would just go about their lives in the middle of the worth pandemic in a century if their governments just twiddled their thumbs.
Frankly, I’d guess that the 7% is a conservative guess at the outbreaks effects on our society.
I object to the comparison of The Netherlands with Sweden. The Netherlands was considerably more strict. Far less so than Italy or Spain, but much more than Sweden.
I think that my country was hit relatively hard given the measures due to two reasons:
– lots of people having a winter holiday in Italy.
– carnival, which involves exactly the kind of behavior that spreads COVID (packed bars with loud music, so people have to shout at close distance to hear each other). Note that the heaviest hit are exactly the Catholic regions where carnival is celebrated (most). The north of the Netherlands has very few cases.
We should have quarantined incoming travelers sooner, but no one else did at that time, so that’s not a difference in measures.
The harder-hit regions are also places where the February school vacation was later (Dutch school vacations are staggered). So people from those areas who went skiing in Italy were more likely to get infected while there, as the virus was more widespread.
Though I’m not saying carnival had nothing to do with it- a lot of the early infections were linked to the carnival in Tilburg.
Completely true. I’ll also add that the Netherlands had stricter interventions than the US.
I am absolutely no proponent of trying to achieve herd immunity, but I think he is wrong about needing 70%. (He doesn’t give actual arguments other than his gut feeling.) The basic calculation for the 70% is: Each person infects on average 3 more people (R=3). If 2/3 of the population are immune, so only 1/3 is still susceptible, then she will only infect the 3 * 1/3 = 1 other people (R <= 1).
However, there is a fundamentally wrong assumption in that: that the infected people are a random sample from the population. But not all people are equally likely to spread the virus further. Assume that the population consists of 50% eremites that never ever meet other people, and 50% party-goers who infect a whopping 6 further people if they catch it. Then on average we have R=3. However, none of the digital eremites will ever catch the virus, so the epidemics will die down when 5/6 of the party-goers are infected. That is roughly 40% of the total population, not 66%, as the R would suggest.
How strong is the effect? I can't quantify it, but I suspect that it is strong for several reasons. First, in my above example, I omnisciently knew that R=3 for the whole population. However, how would a scientist estimate R? She would look at the infected people, and check out how many other people they infect. Since only party-goers are infected, she would only be able to collect data from them. So with best scientific standards she would estimate R=6, and then conclude that herd immunity is reached with 5/6 = 85% infected, instead of the true value of 40%.
Second, how is the real distribution? My example with 50% with 0 contagions and 50% with 6 contagions was completely made up, after all. But the number of social contacts (as most social distributions) has a heavy tail. So the important question is: Which proportion of the population causes 2/3 of all social contacts? Unfortunately, I don’t know the number, but as with all heavy tail distributions, if we take the group with most social contacts, then we would need much less than 2/3. I wouldn’t be surprised if it was more like 20%-25%.
Of course, we cannot just assume that these 25% most social people are the immune ones and declare that 25% infections give herd immunity. It might even be hard to identify the 25% who have the most social contacts. Actually, how could we identify them? Here is a fun experiment to find them (thought experiment, of course): Just release a virus and see who gets infected. This will not literally give 25% of the population which have most social contacts, but it probably comes close.
So several effects work into the same direction: our estimate for R=3 comes from epidemiologically early data, so it probably comes from people who have exceptionally many social contacts. Naturally, during an epidemics the ones that are infected have particularly many social contacts, and due to heavy tails you need only relatively few of them to account for 2/3 of all social contacts.
Again, I do not think that going for herd immunity pays off for the current pandemic! I would think that Stockholm region might be at least half-way there at 20% (without the authorities aiming for that — they emphasize strongly that herd immunity was never their goal). But I think Stockholm was extremely lucky and just a tiny bit worse parameters would have had their health system collapse. (Like, three more days of exponential growth! There weren’t much hospital capacities left.) Cities like Bergamo and New York might also be half-way there, but they are really unhappy about what it took them to get there.
This non-homogeneity is really important.
But it’s also important to remember that there’s non-homogeneity in time as well. Maybe on March 1, people had behavior patterns that made half of them cause 0 spreads and half cause 6. But by now, everyone’s habits have changed – maybe the 6 people are now down to 3. So we only need a two thirds of those people to be immune to reach herd immunity. But if behavior patterns change again, then the number needed for herd immunity will change again.
Both R0 and herd immunity threshold are relational properties of a virus to a community and not intrinsic to the virus itself.
Great comment, Demost
Just using the good old fashioned 80/20 rule, I would expect those getting the virus earliest to be both the most likely receivers and spreaders. They are the critical nodes. Once those nodes get immunity (or die), the R is going to plummet.
This seems to be a point that one person after another is discovering, being struck by, and posting here. I posted it some days back and was told then that someone else already had.
Superspreaders are a caveat to this though. Even if 5/6 of the party-goers catch it, one superspreader event can cause a fresh major outbreak. And additional superspreader events can sustain this outbreak. Fat tails cut both ways. Maybe the estimate of R=6 is wrong for partygoers, it should really be R=20 due to superspreaders, but superspreaders are so rare that none have been sampled in putting together the estimate.
The estimate of R should include lots of superspreaders if there are more than a few thousand cases, since they should be very heavily over-represented in any sample. So if you have 10,000 infections you probably have 100-1000 top .1% super-spreaders.
I don’t know how this jives with Scott’s saying that previous outbreaks followed the simple model for herd immunity. Anyone have a link to some evidence for that?
Could you go into more detail as to why you would expect so many superspreaders? Couldn’t you have just a few superspreaders spreading to a lot of ordinary people?
Social networks (and many others) tend to be so-called scale-free networks. That means that the number of people with x contacts decays polynomially in x with an exponent between 2 and 3. In such networks, there are nodes/people with a very high number of contacts, sometimes called “hubs” or “superspreaders”. For example, if the exponent is 3, then in a network of n people, there is one (or a few) individuals with n^{1/3} contacts. That’s really a lot.
However, most people have only a small number of contacts.
For almost all social networks (including the ones relevant for infections), the exponent is between 2 and 3. This has a few consequences:
1) There are enough high-degree nodes that the network is a “small-world network”, i.e., you can get from any node to any other in a very few hops. Experiments by Stanley Milgram in the 70ies estimated six hops on average. This was dubbed as “six degrees of spearation”. In Facebook it’s more like 3-4 hops.
This is a bit related to the Friendship Paradox that LesHapablap has mentioned below, but it’s not the same. The paradox does appear in all scale-free networks, but is really something even more general: it basically appears in any kind of inhomogeneous network.
2) In scale-free networks, most connections (or infections, for an epidemic) are between “ordinary” nodes, not involving super-spreaders.
3) If you want to estimate values like R, the average number of contacts, then this is possible by sampling. That means, if you want to know how many people a person infects in expectation, then it is fine just to sample a few people, and take the average.
That sounds obvious, but it is not always true for such heavy-tail distributions. For exponents smaller than 2 your sample would not hit enough super-spreaders, and you would always systematically underestimate the expectation.
To understand the growth of an infection, we are in a somewhat lucky situation: We only need to know the expectation of R, so how many people an infected person infects on average. It does not really matter how big the variance is. (Unless you are in a regime where you can count the number of infected people by hand, but that’s a different story.)
So that means for the R-value: we only need the expectation, and we can get it by looking at some cases and taking the average. We don’t need supermany cases. We will always catch a few moderately heavy spreaders in the sample. We might miss super-spreaders altogether, but that’s ok — they are spectacular, but they don’t dominate the expectation, and they don’t dominate the spread of the infection.
This article claims that different diseases have different levels of dispersion, and thus different levels of how important superspreaders are.
This is really interesting. It suggests that the corona-diseases (Covid-19, SARS, and MERS) are quite strong outliers in that aspect, compared to other respiratory diseases like influenca. I.e., that superspreading events are much more important in corona-diseases.
I’m no expert I’m just running off intuition. But I believe it is related to the Friendship Paradox:
https://en.wikipedia.org/wiki/Friendship_paradox
That is, your friends, on average, have more friends than you.
The wiki article doesn’t really explain how this relates to superspreaders, but it does mention this:
In addition to that, activities that make you a superspreader put you in contact with other superspreaders. For example:
Let’s say you’re in a society where 1/8 of the populace go out to night clubs or bars or parties every night (superspreaders). 1/8 go out to bars and parties and nightclubs twice a week(medium spreaders), and 3/4 don’t go out at all. If all the spreading happens when people go out and mingle, then after a few nights the majority of your infected population is superspreaders, some are medium spreaders, so they are way over-represented. That is, the same thing that makes them super-spreaders makes them more likely to get infected too.
So in real life, your ‘parties’ from the example above are prisons, churches, meat packing plants, rest homes, bars, maybe airplanes and subways.
This isn’t necessarily true though: say your guy was a superspreader because he worked in a mask factory and if infected would cough all over the masks. Now the infections can only go one way, so although he’s a superspreader he isn’t more likely to get infected.
Most superspreaders though, they are also much more likely to catch as well as spread.
I suspect one aspect of being a superspreader is your social network, but that there’s a bunch of other stuff involved.
One plausible (at least to me) model for this is that you need to end up with a bunch of things aligning at the same time to get a superspreader event: You have to be at high contagiousness (probably within a day or two in either direction from the onset of symptoms), you maybe need to be someone who just naturally makes a lot of respiratory droplets, you have to be in an environment that optimizes for spread of those respiratory droplets, and you need to have lots of people around you who are susceptible. Cut any of those out, and you infect one or two people, not a roomful.
Fans and air conditioning seem to be a big help in spreading the disease. Basically air conditioning or refrigeration helps the virus survive longer in the air/on surfaces, and the fan ups your range. Singing or talking loudly or breathing heavily basically increase your range and your output of droplets. Crowding in a small (ideally closed-in) space means you maximize your number of targets.
Most people are still going out to the shops and to exercise, key workers are still going to work.
Does the mobile phone data have a way of differentiating between this and breaking lockdown? (Noting Scott sees it as evidence of people not following lock down)
Theoretically your phone knows where you work (if it’s the same location every time). So they could filter it out. And shopping trips and exercise would also happen before the lockdown, so we’d expect trips to decrease as extra trips are cancelled with the lockdown.
Whether the graphs already filtered for this is not something I know.
Did anyone else quickly check Trumps twitter feed to see if the silica “Do Not Eat” packets thing was definitely a joke?
Poes law is hard sometimes.
So… apparently a weekly neighbourhood scream has become a thing in some places:
https://i.imgur.com/5s0UvtH.jpg
More and more I’m convinced we’re in the weird timeline, one of the ones where the time traveller realises they’ve messed something up and jumps back in the time machine.
[gets out of time machine]
“Hey guys, so I just got back from the past and was wondering what 2020 was like”
[As people look at the time traveler an alarm beeps for 5pm. Blood curdling screams echo from outside and everyone opens their mouths and starts screaming too with eyes locked on the time traveler. ]
“Ok… I’m gonna… I’m gonna go.”
I remember in the first week of Italian lockdown hearing about events every evening where everyone would lean out the window and applaud for healthcare professionals, or sing opera songs, or whatever it is Italian people do socially. Last week I heard about a 7 pm applause for healthcare professionals in New York, which apparently has been going on for all these months. It only gets occasionally mentioned in passing in media reports, because I guess to people living in New York it’s too obvious to mention, and to people outside New York it’s something we’ve never even noticed. It makes me realize just how different this period is in different places, with very different social customs emerging.
And then I realize, the world already had this much difference in social customs everywhere in the days before, but because I was traveling a lot, I was relatively familiar with some of the variance (at least, among major cities in North America and Europe) while in the present period, the cultural variation has been reset, and most of us will only ever directly experience one place in this special time.
In Long Beach there’s an 8pm cheer for healthcare workers, but I’ve long suspected it was more popular as something akin to a neighborhood scream.
The fact that the stay at home orders had a moderate to small effect on behavior seems like about what you’d expect, and has relatively little to do with government impotence.
It’s pretty reasonable to expect “very clear evidence that a dangerous highly infectious disease is killing many people in your area” to affect people’s behavior in about that way. (This is also why the economic-impact comparison is a complete non-starter. If you have to stipulate that people will not change their behavior in that situation in order to get the comparison you’re doing the kind of useless propaganda stuff that makes people suspect economists.)
A government order for people to stay away from the virus would have effects on the edges mainly on:
(1) the kind of people who are angry about the idea of following obviously good advice out of contrarianism, right wing conspiracy theory, or just plain assuming they’re invulnerable and being totally unconcerned about other people, and
(2) the people, and I think this is the important one, who would otherwise be forced to act in unsafe ways by employers or other private actors with power over them.
What we’re seeing makes sense if the major effect of government intervention is your boss can’t tell you to come in any work without a mask anymore, even if that’s what they would do otherwise. A lot of them wouldn’t anyway, the stay at home orders often exempt the people most likely to be subject to that, and we’re seeing a lot of the new infections in those places as it is.
Also the herd immunity thing is really seriously affected by how long immunity lasts. Relatively few diseases give you lifelong immunity, and if the virus doesn’t make it through the entire population in a couple of months (which it almost certainly wouldn’t) it could just circle back around. You’d end up with something similar to a lot of the viruses that cause colds – one that wanders through the population once or twice a year, basically indefinitely. So the comparison can’t be x% of people die, it has to be x% of people die each year, which is a really big difference if there’s more than one year involved in the analysis.
Typo patrol:
I think you mean “bias towards inaction”.
I’m donating >$10k to Fast Grants, hopefully in the next week. I’m glad to help other people contribute via donation matching. If you email me with a firm amount by 2020-05-23 11:59pm (anywhere in the world), I’ll get your contribution in and assign you a donation once I’m done getting money out the door.
Email address is ross at r-y dot io.
Is here any more information around about why the paper saying that, if there is a high coefficient of variation in people’s ability to both get and spread the infection i.e. correlated super-spreader/getters, then herd immunity is possible at 10-20%?
I verified with my own simulation that this is true, given the assumptions. But are the assumptions correct (i.e. that propensity to get infected and to infect others are highly correlated and are also highly variable with CV=stddev/mean ~3.5-4.0).
In the linked to article the arguments are a) it is bullshit, and b) the S[A]IR model [which assumes this is not true] usually works well.
But I personally find (a) unconvincing. Perhaps this reflects some cognitive bias that I have.
As for (b) there seem to be too many mysteries in this area to think the S[A]IR model is very good. I keep reading, for example, that viral outbreaks tend to disappear for reasons that are mysterious.
I am not particularly attached to this theory but at present I am uncertain how much credence to give it.
“The S[A]IR model” is ambiguous. I’ve seen some such models that assume uniform mixing (which is probably what you’re talking about) but also some such models that assume a non-uniform network structure.
I think the important question is whether assuming a stable network, with high degree nodes as super-spreaders/getters, is a better assumption than assuming that people’s roles in the network change based on what day they go to church or the bar vs what day they stay home.
Two thoughts: 1) Correlation of likelihood of getting and spreading an infection is extremely plausible. Just by the virtue of their occupation, doctors, police officers, and waiters have an order of magnitude more close contacts in a given week than most office workers.
2) The 2009 swine flu was left to spread essentially unchecked, and petered out at a lower infection rate (1/6 of the world) then R0 (1.4-1.6) would suggest.
R0 is descriptive, not prescriptive. What happened was that contact tracing and informal precautions were sufficient to contain the virus, so by definition its replication number dropped below 1.
EDIT: grammar. Apparently I need another cup of coffee.
I don’t think contact tracing was ever enough to keep up with 1/6 of the world population having it. At least, I never had a friend tell me about having been contacted by a contact tracer, and I know a bunch of people who are sure they had swine flu, and probably many more that had mild cases.
And I don’t think the world took very much “informal precautions” either. At least, nothing anywhere near what people have been doing for covid, even in places like Sweden and South Dakota.
So, there’s a few pieces to this.
One, what everybody is calling ‘R0’ is actually R_effective, the difference being that R_effective is cases expected to derive from each case and R0 is that in a fully susceptible population. Usually this is academic, but R_e can vary significantly from R0 paricularly if you have localized outbreaks and not a lot of crossover between locales, since the local population has already gotten the disease and is no longer susceptible.
Two, the epidemiological characteristics of SARS were quite different from the coronavirus even though I understand the virii are similar, in ways that made it more likely to burn itself out – IIRC, it had a much shorter incubation period and fewer asymptomatic carriers, etc.
Three, ‘informal measures’ includes things like the general population being better about washing their hands, staying home when sick, and not sneezing on people, the importance of which I don’t think can be overstated. I definitely remember a lot of messaging around this, and that on its own would have helped a lot.
I have had a friend tell me about having been contacted by a contact tracer a few years ago, when his daughter caught meningitis. Contact tracing was being done already, and it is effective. We were just being overrun by Covid-19.
Since the outbreak in Milan, Italy, people are being quarantined just because of they being a close contact with a positive (usually in the family).
I’m telling you, guys: the relevant authority to understand epidemics is not the medical wing of a university, but the dusty sections of the library, with books from the 1970s from Seth.
Just around the time the Covid-19 epidemic began in earnest, I started reading The Individual and the Nature of Mass Events. So far, his take has been spot-on. Excerpt (with my emphasis):
—–
The epidemics then serve many purposes — warning that certain conditions will not be tolerated. There is a biological outrage that will be continually expressed until the conditions are changed.
(Long pause at 10:31.) Give us a moment … Even in the days of the great plagues in England there were those smitten who did not die, and there were those untouched by the disease who dealt with the sick and dying. Those survivors, who were actively involved, saw themselves in a completely different light than those who succumbed, however: They were those, untouched by despair, who saw themselves as effective rather than ineffective. Often they roused themselves from lives of previously unheroic situations, and then performed with great bravery. The horror of the conditions overwhelmed them where earlier they were not involved.
The sight of the dying gave them visions of the meaning of life, and stirred new [ideas] of sociological, political, and spiritual natures, so that in your terms the dead did not die in vain. Epidemics by their public nature speak of public problems — problems that sociologically threaten to sweep the individual to psychic disaster as the physical materialization does biologically.
(Pause.) These are the reasons also for the range or the limits of various epidemics — why they sweep through one area and leave another clear. Why one in the family will die and another survive — for in this mass venture, the individual still forms his or her private reality.
Why? It’s exactly the behaviour you’d expect from rational actors. Shouldn’t your response be satisfaction at some evidence that people really do behave rationally to a large extent?
Since talking & singing are so important, why are digital contact tracing apps not planning to use the microphone to detect that, and account for it in their probabilistic assessments of transmission risk? Well, I’ve been on a lonely quest to try to make that happen for the past month or so. Everyone I talk to says it’s a good idea, but no one seems to view it as a high priority. If anyone reading this has time and programming experience, it would be a great help to actually have the appropriate audio processing software ready to go (more details here, although I’ve made slight progress since I posted that). Or if anyone knows anyone working on the upcoming Google-Apple contact-tracing OS update, or if anyone knows any epidemiologists who might be able to simulate the effects and put out a paper and press release, or anything else, please reply here or steven.byrnes@gmail.com Thanks in advance!!
Contract tracing apps don’t make probabilistic assessments of trransmission risk. They just ping a bunch of bluetooth messages at each other every now and then.
And the audio processing is probably computationally intensive enough to drain your phone battery in short order.
The current plan is to try to declare “contact” when distance is closer than some threshold and duration is longer than some threshold. The distance is guessed based on Bluetooth signal strength, possibly adjusted by a guess of whether the phone is in a pocket or not (from accelerometer etc.). The duration threshold most people talk about is 15 minutes. Of course this is a probabilistic assessment: transmission is more likely if the phone declares “contact” and less likely if it doesn’t. It’s certainly better than chance!! I suppose you’re probably trying to say that it’s a very noisy assessment, with lots of false positives and false negatives. I agree 100%. I have seen the Bluetooth RSSI data, the spread is huge, it’s entirely possible for two people hugging to have lower RSSI than a different pair of people 3 meters apart. The reason I’m working on this is to make the probabilistic assessment less noisy, with fewer false positives and false negatives.
You say “probably”; what is that based on? The “Hey Siri” functionality is running 24/7 on many phones and is not a noticeable battery drain (I believe, although this isn’t a perfect comparison anyway because I recall that Apple has specialized hardware for that). It’s also entirely reasonable to process a 1-second sample of audio every 30 seconds (for example). That would reduce battery drain and still be a lot better than nothing. I talked to a guy who writes audio processing software and he gave me the impression that it was not at all computationally difficult, e.g. he runs these analyses in web-browsers no problem. I’m not an expert; if you have real information I’m interested to hear it.
All the privacy concerns with these apps would be multiplied if they were constantly listening to all your conversations.
As best as I can tell, it doesn’t undercut privacy at all. The main reason is: the microphone-derived data would be stored locally on the phone and never broadcast to anyone ever.
The privacy concerns with these systems are not about what information is stored within the phone app, but rather what is information broadcast to the government or others. The most important and most clear-cut case will be the contact-tracing OS update written by Apple and Google themselves. If you have a privacy concern regarding how much information is accessible to OS software written by Apple and Google, then of course you better throw your phone in the garbage: The phone OS has access to absolutely everything, and we have always been trusting Apple and Google to be good stewards of that.
That said, perceptions of privacy are not exactly the same as actual privacy, and I acknowledge that it’s possible that people might make dumb wrong arguments to this effect which might motivate some people to not opt in. I don’t currently think that this a good reason not to proceed and make the app work better; after all, people might make dumb wrong arguments about any aspect of the system, and it seems silly to design around that.
In a system designed with all the attention to security and reliability we’ve come to expect from Silicon Valley, but with an extra dose of haste and the firm conviction that they are doing God’s Work? I’m skeptical.
Yeah, I would never, ever, opt in to this. And it’s not correct to say the only privacy concern is about data that is broadcast–data stored only on my phone can also be accessed or searched by the government, sometimes without a warrant.
That’s an understatement – Moscow and Beijing never apply for warrants.
The status quo plan is that each phone store a list of data like “I was in contact with a phone that emitted the message 2955893986, with Bluetooth signal strength 7, for 20 minutes.” The modification I’m advocating is to store a list of data like “I was in contact with a phone that emitted the message 2955893986, with Bluetooth signal strength 7, for 20 minutes, while the estimated respiratory droplet level was 2 (out of 10).” I don’t see any scenario where this is meaningfully worse for privacy, even in the unlikely case that the government seizes your phone and accesses these logs. Especially when other phone data logs contain much more sensitive information.
I mean, you can say “Everything Google and Apple do is terrible and buggy and therefore, even though the privacy protocols are great on paper, they will be implemented wrong and leak information.” But even then, I would think the main concerns would be leaking your identity, your location, and your medical information (i.e. that you do or don’t have COVID-19). Compared to those, leaking the fact that the microphone did or didn’t hear someone talking within earshot at 2:38 seems relatively innocuous to me.
And again, the context is, a large majority of adults are already trusting Apple or Google to write their smartphones OS. That is a massive level of trust. I don’t understand where you’re coming from if you don’t trust Google/Apple to not leak your location and identity in the contact-tracing OS update, but you do trust Google/Apple to not leak your location and identity in every other OS update and line of code.
You can also argue that a skeptical public won’t opt into these systems and therefore there’s no point in trying to make the systems work better. I mean, that’s entirely possible. But I happen to think that it will probably get to high participation rates in at least some places, whether by public mandate or otherwise, or at least that this is sufficiently likely that it’s totally worth putting heroic effort to make the systems as effective as possible. Incidentally, 90% of Americans have favorable impressions of Google and 81% have favorable impressions of Apple, so even if you personally think it’s a no-brainer to not opt in, it’s still possible that you’re in the minority.
Given the fact that most people’s entire cell phone location history is available, its hard to disagree.
You can sort of opt out of location tracking but not without crippling many useful features.
This ship has sailed – we traded privacy for useful software features a long time ago.
@steve3920 There’s survey data on this, actually. 82% of Americans have a smartphone, and about half of those who do would not use such an app. So only about 41% are willing and able to use such an app—it’s not just me. Admittedly, people’s opinions can change with time, but there is not a whole lot of trust in Big Tech out there.
@caryatis Interesting, thanks!! The number could go up or down depending on popular narratives.
Some people have talked about contact-tracing dongles / wearables. A school could buy one for each student, or a company could buy one for each employee, etc. Then the school / company / etc. could make them wear it when they’re on the premises. This seems like an awesome idea to me. The economics work, the systems could actually be more accurate, you don’t need people to have smartphones, and when you’re at work/school there’s already generally a culture of wearing badges and following rules and not expecting privacy. Those things obviously only catch the contacts between employees/students on the premises, but that’s still something. I don’t understand why this hasn’t already taken off.
I like the idea, but I can’t think of any way to filter out recorded sound. People listen to music, and watch television that has crowd scenes all the time (well, a few hours a day). Watching sports on the television or online is hard to distinguish from being near people singing and shouting. Content ID could filter out most recorded music, and a fair proportion of video, but it really can’t be done on a phone. Short of uploading the data to the cloud where audio matching could be done, I can’t see how to distinguish the two.
Consider, a hard case, where fifty teens are having a party with loud music in the background. This might seem like recorded music, but if the teens are dancing and singing along it is perhaps as bad as any spreading event. Similarly, fitness classes have been the sites of super-spreading, and they also have loud music.
Correct. We’re not going for perfection, we’re just trying to make it less bad. When there’s talking, you don’t know whether it’s the TV or a person. But if there isn’t talking, and the environment is quiet enough that you would be able to hear talking, then you know that nobody is talking. So if you raise the threshold on those interactions—say, 30 minutes instead of 15 minutes, then you reduce false alarms without excessively increasing misses.
You might be thinking, “So what, who cares about false alarms. Misses are far more damaging!” But the thing is, too many false alarms are a big problem, because people will stop complying with the endless quarantine requests that don’t end in them getting sick. Either they’ll figure that they must have already caught it and now they’re immune, or they’ll lose faith in the systems, or they may even simply run out of ability to find substitutes for their jobs and other obligations etc.
And that’s why the systems have a threshold of 15 minutes, not 10 minutes or 5 minutes. Of course it’s possible to catch it in 5 minutes! But the designers know how important it is to reduce false alarms, and are already planning to do so even in exchange for missing some transmissions.
Anyway, if you don’t care about false alarms, you can do a trade: The quiet-and-no-talking interactions have their threshold go up from 15 minutes to 30, and the loud interactions (including people talking, but also TV or music) have their threshold go down from 15 minutes to 10 (or whatever). Now we are holding the total number of false alarms fixed, but reducing misses on net.
This doesn’t seem like a bad idea. Some places you can post to if you haven’t already: r/machinelearning, the fb group Artificial Intelligence and Deep Learning, or AskHN (on news.ycombinator.com). Before you do, I would recommend you to setup a github repository, which AFAIK does not require coding skills, with a FAQ where you answer some of the questions people asked here.
My worry is that contact tracing apps are basically dead in the water, since those countries that have them already have very low participation rates. For Singapore it is around 20 percent, and for Austria it’s probably much lower than 10 percent.
Thanks! Good ideas! https://github.com/sbyrnes321/audio-respiratory-droplets
> if that were true, right now we’re on track to gain herd immunity in 30 years. This would be another worst-of-all-worlds scenario where we have all the negatives of a long lockdown, but everyone gets infected anyway.
Is gaining time for better treatments, or early vaccines that are at least less risky than the disease not a rational option? (And what became of the optimistic Californian ideology “technology is the solution”?)
The delayed economic costs of too gentle or too early released restrictions (R too high) — have they been modeled for the US?
An example is a simulation for Germany (no English available) that combines epidemiology and economy. It showed that there is an economically optimal R between .5 and 1 (diagram 4 in the linked pdf) (assuming only one optimum).
I can’t judge the quality of that paper, so, if someone wants to bust it, go ahead.
It’s a worst case scenario, of course. The problem is how “patchy” all of these things are, and how that interacts. Meanwhile, we’ve got all these second order effects piling up–if we had some specific treatment or timeline firmly in sight, we could at least sort of rationally plan around it and have some common goal. Without that, it’s not psychologically doable–because we’ll fight all the time about whether we should extend the lockdown instead of trying to figure out how to make more practical accommodations. It’s a recipe for dysfunction and costs on a lot of levels, especially with the polarization and class/geographic divides.
We can wait around a bit longer, but there’s no guarantee anything that makes a big difference shows up soon. It’s not clear what mechanism we’d target to treat, or how many people that would work for. There’s no clear target to work for. I’m sure we’ll find some things that help, but will they help the most seriously ill? Will they just make the illness a bit milder or actually save lives? Will they have side effects? If they take several years, many of the most vulnerable (for example, nursing home patients) may have passed away. More will have taken their place, but their quality of life will also have been sadly diminished by total lack of visitors. I’m not religious, but many people would rather go to services than hold out for a year hoping for the best. Very few people are pure lifespan maximalists, and unfortunately a lot of the things people get the most quality of life out of are directly implicated here, which is why trying to “balance” it via a model like the one you quote strikes me as less sensible than it sounds. Then you get into the whole issue, if there are structural and economic displacements and failures of various kinds, will most people be able to get access to the treatment? It may turn out that precautions for the most vulnerable will be about as helpful as any treatment benefit we’d get in a reasonable period of time.
Then, with vaccines, assuming we get somewhat lucky, there’s still the issue that apparently coronavirus vaccines often have problems in later trials because of the autoimmune response thing causing bad side effects. I’d be afraid of rushing that kind of vaccine for what is a mild illness in most people–I know there can be scary longterm side effects, but that could also be true of a rushed vaccine. It may make sense to give it to some vulnerable groups, and it may come to be something that has some overall impact with time and building off existing immunity. But aren’t some vulnerable groups unable to receive vaccines due to their conditions? That’s why we rely on herd immunity, but it doesn’t seem likely to be as reliable as for other illnesses, due to ease of asymptomatic spread and possibly limited immunity. But imagine the scale of vaccine production and distribution it would take to make people feel there was reasonable protection such that it is worth reasonably severe mandatory measures until then. The whole world would need it and it would take a whole lot of time, plus the logistics are tough–if they go to a center to get the vaccine, they risk infection, if it doesn’t kick in in time. Some people would refuse the vaccine (this may not matter much, it would depend on circumstances). A lot would probably neglect a booster dose if needed. The lockdown procedures can really only be maintained when the goal is defined as something more than finding something with the possibility of lowering risk somewhat. As long as we insist that any possibility of being infected and inadvertently spreading it to another is unacceptable, and therefore any “unnecessary” risk of contracting it is immoral, which is what mandatory strict measures basically need for justification, we have to go for virtual eradication before bringing back global travel or concerts.
There’s just a *lot* going on here that might provide some sort of partial solution on some timeframe, but it’s hard to say what benefit it would provide. When you weigh that against known issues of lockdown and alternative mitigation measures, and the risk of worst case scenario, it’s just hard for me to see it being a workable approach. It sounds like a sensible idea, but in practice it is harder to tell.
Thanks, that put some ramifications on my radar I had not seen.
Obvious hypothesis on voting by mail: there are and have been a bunch of other issues around obstacles to voting where making it easier/harder to vote does help the Democrats/Republicans, especially if your translation back to the Jim Crow era is “helped the spiritual ancestors of modern Republicans/Democrats” rather than “helped the people who were Republicans/Democrats then”.
I think that’s given the two parties strong instincts to support making voting easier/harder (I’m not sure the distinction between classing those instincts as expedient or principled is meaningful, because people’s brains don’t usually work the way their owners think they’re working).
And those instincts are applying now, even if it’s not clear that the reasons they developed apply here.
Also, I think a lot of people are aware of the political effect whereby people take measures that are politically good for their party and then rationalize an explanation for how it fits their party’s stated principles; but I suspect the other effect is likely nearly as strong. Expansion of the franchise and prevention of fraud are two central principles of the Democrats and Republicans respectively, and the parties have each rationalized an explanation for why their principled view is also good for them politically, even in the absence of any such data.
> …we’ve all seen pictures of people going to the beach unmolested. [ … ] What about all those pictures of empty freeways during rush hour?
Pictures can be tricky and manipulative. Here is a comparison of scenes taken from different angles and swapping wide angle for teleobjective. (Kids: take one of the paired pictures and find out from what direction in it the other one was shot.)
I think you forgot a link.
You think right.
Corrected.
Poland made some steps quite early (closing schools, closing borders, lockdown, even forbidding to enter parks at some point, face masks).
No idea whatever it had any real effect. Except killing the economy and some hilarious reaction, like the same person German TV slamming Poland for terrible act of closing borders. And days later praising Germany for a great act of closing borders.
I suspected that low case rate were caused by poor testing, but now testing ramps up and there is no explosion of cases.
We are reopening now, so I am curious whatever it will change anything.
like the same person German TV slamming Poland for terrible act of closing borders
You could have stopped right there.
Which person was that supposed to be.
Also might part of the problem why this person “slammed” Poland was, that this literally left an traffic jam until behind Berlin, of Polish citizens stranded in Germany?
I’m convinced that the early lockdown pretty much saved us. There’s plenty of horror stories about doctors returning from holidays in Italy straight to work, hospitals becoming the hotspots for the epidemic by ignoring symptoms in patients until they infected everyone around, permanent shortages of testing equipment, people not even getting informed they’re supposed to be under strict quarantine, politicians ignoring rules they themselves enacted. Even now, the virus continues to spread among coal miners forced to work in their regular unsanitary conditions, despite people having shouted about this being a problem for months. Without the lockdown, and the resulting enforcement of restrictions on various businesses, that could have been the entire country right now. We’d also be screwed if we tried to rely on institutional response and proper procedures, or targeted interventions like test-and-trace, as our institutions seem to be comically unprepared to perform them.
Instead, we’ve had the government quickly sending a reliable signal that the pandemic is a serious matter, and people at large listened and complied. But perhaps “complied” is the wrong word considering the derisive, antagonistic reaction to a ban on entering parks and forests. Or the fact that when our governing party subsequently tried to force an election in the middle of the pandemic, it essentially got stopped by the general non-compliance of the electoral commission, municipal governments and the public at large (including own supporters). We, the people, do not trust our government, but we are taking the situation seriously, and it works.
I was struck by how this post was feisty, fearless and funny. Even more than an average SSC post.
The only quibble I have is that after acknowledging how Countries have different testing rates and different judgements on whether people died from or with the virus, the post still went down the route of ‘let’s compare countries anyway’.
Early in the European outbreak there were many discussions about how Italy had a 500% greater mortality rate than Germany. To a first approximation all of that can be explained by testing differences and Italy recording mortality differently to Germany. Italy effectively made people immortal from cancer, diabetes, emphysema (etc etc) – you simply contracted Covid-19 and you couldn’t then die from anything else. The reverse was true in Germany – if you had any vaguely serious condition, it meant the virus couldn’t kill you. Bingo – 500% difference in mortality explained.
Italy and Germany stand out because the difference between them was extreme, but it seems to me that we’re no better off comparing rates of infection or mortality between countries with more similar rates of whatever, because it is still likely that significant differences are the result of how each country tests, measures, records and estimates.
I appreciate the temptation to look at how Sweden, say, is doing compared to Norway, or Belgium. But the obvious confounders haven’t gone away just because at one point earlier in our analysis we mentioned that ‘of course we must recognize that testing and measuring varies a great deal between countries’
I say this because I keep finding myself looking at, for instance, the case numbers for various countries (which are always a whole, specific integer, like 27,568) and thinking that it is a reliable datum. And doing so ten seconds after reminding myself that you could multiply it by any number between two and ten, and have a more accurate datum.
ETA I’ve read through the post again and on second reading Scott seems much more cautious about inter-country comparisons than I thought. So, that mostly negates even my minor quibble.
“And doing so ten seconds after reminding myself that you could multiply it by any number between two and ten, and have a more accurate datum.”
Is this true? Imagine the tested incidence is 10 per 1000 and I multiply by ten to reach 100 per 1000, but in reality testing is good enough that 50% of cases test positive, so the real number is 20 per 1000. Seems like the original datum would be closer than the fudged number to account for missing cases.
Having 50% of your tests coming out positive tells you nothing about the incidence in the population – if you only test obviously symptomatic people, you could get a 90+% positive rate, and still have no idea what the prevalence of the virus is.
It’s fair to say that as testing becomes more prevalent, the discrepancy between the tested case rate and the true incidence should diminish, but globally (which is what I meant, if it wasn’t clear) I would imagine that the difference is still at least 5 times, so multiplying by between two and ten times will still get you a more accurate result. If it sounds a bit hyperbolic, I apologize – my point was really that as we have very little idea of the true incidence in different countries it’s very difficult to make comparisons between them.
How this data would deal with people leaving home at lower frequency?
before: leaves home for 16 hours a day, hugs people, sings in a choir etc
after: walks dog once a day for 20 minutes while keeping 20m+ distance from people
I suspect that both before and after would show as “leaves home daily”.
I’m not sure how true this is for the Netherlands specifically. There was some confusion initially, but since March the government has denied that it is seeking herd immunity.
All restaurants and bars were closed (they are reopening on June 1 with various restrictions), as were cinemas, theatres, ”contact professions” such as hairdressers, gyms and schools. Sports clubs were closed (for their adult members, children were allowed to return earlier) until last week- they are still required to keep their changing rooms closed, and sports are only allowed if they can be practised outside while keeping 1.5m apart.
In general, I don’t think the Dutch lockdown was significantly less strict in practice than the German one (though the latter varied by state). The main differences from what I can see are that the Germans ordered shops to close while a lot of Dutch shops closed voluntarily, and that the German football league is resuming behind closed doors while the rest of the Dutch season has been cancelled.
Note that Germany did not close its border with the Netherlands (though people were told to avoid non-essential travel across it), while most of its other land borders were closed.
The Netherlands peaked at around 84 on Oxford’s Stringency Index (an aggregate of a variety of governmental policy interventions*). This puts it in the “more stringent” half of the distribution.
They’re certainly not an outlier.
*Context: Germany peaked at 82, Italy at 96, and Sweden at 47.
Personal experience from Czechia (where we seem to have contained coronavirus reasonably well):
The biggest factor is probably luck – we got hit later and thus were forewarned. People started to take stuff seriously once the numbers from Italy started coming in. We prepared Covid wards in hospitals that ended up being half empty. This gave us time to sort out the operational issues under low-stress conditions (and hopefully would translate to a better response to a potential second wave)
As for the response:
For quite some time, people have been reasonably adherent to both official and non-official calls to social distance, wear masks etc. Some of the government actions (e.g. mandatory masks) were even likely triggered by hugely successful social media campaigns (people showing how to make DIY masks have gotten pop-singer levels of views on YouTube). And many grassroots initiatives have sprung to actively combat the virus or its effects (like a nano-fibre research facility being converted in a week to spit out mask material or schemes to help neighbourhs), it really was a pleasure to watch. We didn’t really have any people openly defying any of the measures.
This is all despite the government did mess up many things (e.g., misguided attempts to control the PPE market which made availability worse) and has not been very consistent in neither messaging nor specific actions. Part of this is IMHO that the government has not done any crazy strong enforcement of some of the more contentious regulations, so people didn’t become annoyed. For example, of the few interactions of policemen with people without masks I’ve seen, the police was very professional, polite and ended persuading the person to use an improvised face cover without using force/fines/….
Note sure what this means, just sharing. As the restrictions lift, people are being less careful so we’ll se what happens next.
Note: This is true of the bigger cities, not sure how much it applies to smaller centers, but the cities are likely the most problematic parts anyway.
Also at one point I met a friend to barter paracetamol for hand-made face masks, which is definitely peak Fallout moment of my life so far.
Can confirm what Blueberry says. Also, I hate to be that guy, but one can’t really compare Belarus or Russia to Czechia in any meaningful way: on the one hand, Czechia is a richer Schengen country in close proximity to northern Italy, which probably means different initial case load and source country. On the other hand, it is a fairly stable democracy, not (yet) run by a dictator clown. I wonder, though, what constitution experts will have to say about some of the steps being made; it’s also fairly interesting to watch the upheaval in more authoritarian-leaning states in the neighborhood. In Poland, for example, no-one really knew until the last moment whether presidential elections will take place on May 10 as scheduled (they didn’t; see this helpful infographic of possibilities made several days befor the intended term); in Hungary, the prime minister has instituted military control over “strategic” companies and declared state of emergency with no set end.
This probably smacks of Czech exceptionalism – to provide some balance, let me add that there seems to be a completely blockeaded plan to create our own vaccine from scratch.
I hate to be that guy, but one can’t really compare Belarus or Russia to Czechia in any meaningful way
Of course not. Czechia ended up under Soviet domination due to historical misfortune, but it is culturally still much closer to the German/Austrian Holy Roman Empire world than it is to the Eastern Slavs or the Balkans (and so is Slovenia for that matter).
Perhaps I am overlooking something blatantly obvious, but I think there is a very simple explanation for most of the variance in Europe. The virus has spread geographically, roughly from southwest Europe to north east Europe, so a country is generally doing good the more north and east it is. (More precisely, it spread from Lombardy and Madrid/Valencia region, so south of Italy is better than north of Italy.) This is strongly(!!) modulated by how severe the measures are. Reactions in Europe were not synchronous, but the measures were “spreading” faster from south to north than the virus could spread. So in general terms, north/east European countries took measures at an earlier stage of their respective infection curves.
The fatality rate is linked to the total number of cases per capita; the more stressed your health care system is, the less effective it is. This effect is strong on the bad end of the curve (your health system breaks down), and mild on the other end. Also, the case fatality ratio generally increases over the course of the epidemic, because people continue dying for quite some time after you have cut down the number of new infections. This can easily make a factor of 2. So if you look at the case fatality rate at the peak infection time, you might be underestimating it by a factor of 2. Finally, the earlier a country is hit, the higher the mortality rate, because people do get better at preparing their health system and treating the disease.
Examples in Europe: Italy, Spain, parts of France are devastated. They were hit early, unnoticed, when public soccer games were still taking place. Their hospitals were overrun. This caused the very high mortality rates. The sick simply could not be treated, and they died. The same holds for the southern part of Switzerland (Ticino), and to a lower extend to the southwestern part (Genf, Valais, Vaudt) of Switzerland, with the difference that these parts could barely hold their health system from collapsing.
Going a bit higher to Germany, Netherlands, they were hit later, when the measures were already partly in place. Germany had a slightly faster reaction, so it was hit less severe. Northern countries like Denmark, Norway, and generally Eastern European countries were hardly hit because measures were already well in place when the epidemic stroke.
Notably, countries had their fate in their own hand. Greece had an early response that deserves praise almost as South Korea, Taiwan, and Australia/New Zealand, and they could basically completely avert the disease. On the other hand, UK had an unusually late response, so they were hit pretty hard despite being north. And Sweden had a soft response, so they have more than 3 times as many deaths than Denmark, Norway and Finland taken together (with less population than those combined). They could afford that because they were geographically lucky. If Italy or Spain had tried that, the result would have been quite apocalyptic.
I don’t think there are many outliers from this rule. Belgium is one. They have a quite different definition of “corona deaths” than other countries (e.g., you don’t need to be tested to count as corona death, being dead and having had symptoms is sufficient). But I don’t think this explains all of Belgian Weirdness. Still, I don’t see many other outliers.
I don’t know too much about the development in the US, but I think that the rule generally applies to most of the world. (Except for Japan. I don’t have a good explanation for the Japan Miracle.) If you are hit early, you have to be extremely good to avert disaster. China, South Korea, Taiwan were extremely good, and they could compensate for their unlucky position. Iran could not. If you are hit at a medium stage, you could manage well with average to good responses, like the US west coast, Thailand, or Malaysia. Or you could do a really good job like Australia, or a really bad job like Russia. If you are hit late, you generally have an easier job because there are enough tests available, you know better how to treat patients, and so on. But if you don’t have a good health care system and no strong government, like many third world countries (or you don’t care, like Brazil), you will still face disaster.
So summarizing, right now the hypothesis: “hit earlier = hit harder, and government response can change that in either direction” seems to explain really, really much.
In the US it’s a bit harder to say. So far the hardest hit place by far is New York, with secondary hits in Louisiana, southern Georgia, and Michigan. Those places were in some ways also early hits, but Seattle and San Francisco looked like they were infected even a few days earlier than New York or New Orleans, and seem to have done much, much better.
Unless you are claiming that the whole “flatten the curve” meme was a hoax, this is obviously wrong. Yes, the number of people who eventually catch the disease will be (approximately) the same as, but not so many of them will die because they won’t all be ill at the same time.
Now, there is a useful analysis to be done about exactly how long and how strict restrictions need to be in order to keep the the infection rate as high as possible without overloading the healthcare system. Only if the answer is “much longer than we are willing to contemplate” does healthcare system capacity cease to matter.
Is the flatte-the-curve meme a hoax? Well, even the WHO does not know exactly: evidence is inconclusive.
Its not obviously wrong, the flatten the curve meme only looked at a very limited set of variables and could be ‘correct’ without being right.
“Flatten the curve” has dividends not just in healthcare system capacity in terms of beds, but health care system capability in terms of treatment.
Our ability to treat the virus, even without an explicit “cure,” has improved significantly and it seems reasonable to believe that CFRs will trend downwards and continue to trend downwards.
The “flatten the curve” meme is too incoherent to be either truth or hoax. But the common early belief that a tolerably brief lockdown of a few weeks to months would flip us from the hospitals-overwhelmed state to the hospitals-can-cope state, was always mathematically implausible. That’s been covered here from the start, though I can’t recall whether Scott himself has stated it explicitly.
Sweden has shown that it’s possible to burn through the virus at a rate where a lot of your population gets it but your hospitals are never overwhelmed.
It’s unknown whether it’s actually a good strategy.
Sweden isn’t admitting anyone over 65 to the hospital with Covid 19 symptoms. Most countries won’t be that heartless.
I can’t find this with a quick google. Do you have a citation?
Burning through at just the right rate so as not to overwhelm the healthcare capacity is in actuality pretty easy to do if you think about it. First, you allow the disease to spread to a level where you can just manage it, and then (a few weeks in advance, rather, since need for care lags the infections) you take measures to bring R_0 to exactly 1. Sweden appears to have done this (here’s a graph showing the number of ICU beds in use which, while a bit old, shows the number plateauing at sustainable level slightly above level predating the crisis but below the current increased capacity).
Of course, this requires these measures to continue, lest you go back to exponential growth. Contrary to the image sometimes seen in media, it’s not business as usual in Sweden. Wikipedia has the following summary on Swedish social distancing:
In addition, despite lack of enforced restrictions, many restaurants and bars have closed down, and Sweden actually suffers a greater increase in unemployment than the neighboring Finland. Actually, restrictions in Sweden are near-identical to what you have in Finland: In addition to ban on large gatherings and requests for voluntary social distancing that Sweden employs, Finland closed schools and libraries (they’ve since been reopened) and restaurants are only open for takeaway. All businesses, public transport, gyms, etc, have been allowed to remain open, although they are less active and patrons are requested to abide social distancing measures (largely the same as Sweden). Consequently, instead of Swedish R_0 of ~1, in Finland the country-wide average has been reported to be .8, which is pretty much what you’d expect: the differences like restaurants open for takeaway vs restaurants open with restrictions can’t be that enormous.
To get back to the original point, as Sweden shows, it’s definitely possible to let the disease spread at level that doesn’t overwhelm the healthcare system. On the other hand, even if you do this as quickly as possible, it takes a while: unless herd immunity within superspreaders (who, due to exposing themselves to situations where they are likely to spread the disease, are also likely to themselves contract it and thus become immune) reduces the immunity levels required for herd immunity in the population significantly – a very realistic possibility – Sweden by large is still long ways off (although Stockholm and Göteborg probably are getting closer). Moreover, if you can keep R_0 down at 1 when there are several thousand true cases of infection every day, wouldn’t it be preferable if you enacted those restrictions when there’s fewer daily infections and maintained that low level indefinitely? Sweden is one possible example of the “new normal” until we have a vaccine or truly successful testing and contact tracing regime, but this does not need to involve lots of people getting stick.
> you take measures to bring R_0 to exactly 1
This sounds like it should be extremely difficult. We don’t know very much about the spread of the virus (are surfaces an important vector? how much does ventilation matter? etc.) We already know people are very bad at estimating which actions they can take do more or less to reduce the risk of car crashes or mugging or other familiar risks – how should we expect people to moderate their behavior in just the right ways to keep R_0 at exactly 1?
What’s really weird is how many countries are showing data that appear to support the idea that R_0 is very close to 1. This is a major mystery to me. Is this coming through carefully calibrated government action? (Unlikely.) But if it’s coming through public response to public information about infections, then why hasn’t every country reached this balance?
“We need exactly 1” is overstating the case, a bit.
Cuomo’s plan for opening regions of New York called for hospitals to be at no more than 70% capacity, and as they unlock they keep R_whatever at less than 1.2. They monitor case load to predict hospital load, so they have some Slack in case there is a surge that gets out-of-hand.
So, we just need to predict the future, and then solve for 1.0 an equation where we don’t know the values of any of the terms to better than a factor of two. Easy-peasy.
Coming next, my easy recipe for making a fortune by trading financial derivatives.
Driving a car through traffic involves at least as difficult a mathematical problem. We don’t do it by a closed form solution but by making use of negative feedback.
As long as you have control variables with effects of known sign and substantial, if unknown, magnitude, you use them to decrease R0 when you observe the number of cases increasing, increase it when you observe the number decreasing. You need to allow a substantial error margin because of time lags and information uncertainty — but that’s true for driving as well.
@DavidFriedman: But your car doesn’t take a week to respond after you turn your steering wheel.
@A1987dM:
I take a noticeable fraction of a second to respond after seeing a reason to turn my steering wheel or step on the brake, during which my car travels fifty feet or so. That’s a good reason not to tailgate at sixty miles an hour.
Similarly, the delay of a week or so between an increase in the infection rate and it becoming known, or between announcing a change in recommended social distancing and people changing their behavior, is a reason not to try to keep your emergency rooms 99% full.
Particularly as this goes on for longer and longer, we will get better at treating it and will dedicate more and more of the economy to treating covid19. At that point we’d not be flattening the curve but raising the bar to meet the curve.
The endgame is that the free market creates domestic automatic ventilators robots, and people spend on average a couple of weeks per year at home in induced coma by this small robot, tho I’d say this could be around year 20 of the post-covid19 world.
I invite everyone who things the Flaten-The-Curve meme (understood as “if we prevent everyone to get sick at the same time, we give the health industry time to care for those who are sick, preventing triage, and give them time to develop better treatments”) is a hoax, to explain the sudden drop in the EuroMOMO excess death data to me.
If you want to consider the downside risks in one direction you ought to do it for the other direction too.
What happens if immunity only last a limited amount of time, say 12 months?
What happens if each time you get it there is permanent damage to lungs caused?
What happens if this damage accumulates over time and that most people die after they’ve caught the disease 9 or 10 times?
What happens if the impact of this is to reduce average life expectancy to 40 or 50 years?
Will we look back and wonder why we didn’t take a bit more economic hardship to eradicate the disease instead of placing such a harsh burden on the humanity of the future?
What happens if peak load overwhelms the health care system?
Yes, I agree completely. If you’re examining hypotheticals, you ought to examine all of them. And if that is, indeed, what happens, I think the people’s response will be far less measured than merely “looking back and wondering”.
This is just Pascal’s mugging- what if the virus mutates and kills 100% of the population… well at least we won’t have to look back and wonder why we didn’t eradicate it!
Scott isn’t playing a childish what-if game, he’s asking about cost benefit analysis which requires you estimate how likely your solution is to work, not throw out impossible to estimate scenarios as if they somehow counterbalance things.
It’s not Pascal’s mugging to consider very reasonable failure modes.
So “We will never invent a vaccine” is a reasonable possibility since we’ve had other viruses for which we never had vaccines. One that looks less likely by the day for this one, but still one to keep in mind.
And “Infection doesn’t give you long-term immunity” or “each infection makes the next one worse” is also a reasonable possibility, since we’ve seen it before with other diseases.
Ah yes, reasonable that this would drop 30-40 years of life expectancy for an illness that mostly kills people with 5-10 years of life expectancy left. To get that level of a disaster Covid would have to kill a huge amount more people and start killing much, much younger people at a much, much higher rate AND people would have to not change their behavior at all in the face of such an epidemic.
Infection doesn’t give you long term immunity translates into- vaccines are unlikely to give you long term immunity which means the lock downs are doing nothing at great cost.
This doesn’t imply that the scenario of every possible bad thing happening together is a reasonable option. The option of ‘we won’t ever get a vaccine’ is a one conditional event, your approach is to take 3, 4, or 5 conditional events and act as if those are equivalent to a 1 conditional event.
EDIT: Sorry, I confused the OP and the respondent thinking they were 1 person which makes some of this clunky but not incorrect.
It’s a quite unlikely outcome, but it still is a plausible outcome that is based on legitimate uncertainties about the pathogenesis of COVID-19. It’s important to note that how unlikely an outcome is should be balanced against the significance of it’s outcome. Even highly unlikely outcomes should be considered if their impact is significant enough.
That said, I might have overcooked things with the outcome of a life expectancy of 40-50 years. A global reduction in life expectancy of 10 years would a more plausible outcome given the current evidence and uncertainties, yet still be significant enough to justify serious consideration of the potentially immense costs of letting the virus run free.
With which diseases? Unfortunately my attempts at googling are overwhelmed with Covid stuff.
I think TB works this way to a limited extent, if your first case doesn’t give you immunity your second has a much increased chance of mortality, but that is IIRC and not to be taken as truth.
Dengue, too.
To be clear, I think the chances of either “vaccine won’t work” or “you won’t even get at least a year of immunity after recovery” are both low-probability events. But still around a few percentage points, and extremely bad if true, so it’s not irrational to worry about them.
Cold-causing coronaviruses seem to provide you with medium-term immunity (maybe a year or two), but then you can catch them again, just with fewer symptoms.
“So “We will never invent a vaccine” is a reasonable possibility since we’ve had other viruses for which we never had vaccines.”
If you’re talking about something like AIDS, I am not aware of people getting AIDS and then “getting over it”. The fact that it is possible for people to have an immune response triggered by the virus that destroys the virus is strong evidence (albeit not absolute proof) that is possible to trigger an immune response capable of destroying the other than infection by the virus.
How is your objection NOT an Isolated Demand for Rigor?
We have two options here.
Option A is quarantine, and it fails if, as Scott hypothesizes, no vaccine is forthcoming.
Option B is herd immunity, and it fails if there is not, in fact, long-term immunity among people who get sick from the virus.
We can argue about which is more likely, and the failure modes and costs of each option. But you can’t dismiss the possibility out of hand just because you don’t like what it predicts.
(And there is a third, far more terrifying possibility: What if neither a vaccine nor herd immunity are possible?)
They you’d better get used to wearing a face mask and having all your meetings on Zoom….
This is not how it was presented, and is not the question. First the presentation was an escalating list of risks including life expectancy dropping by 30-40 years which is highly asymmetric to Scott’s question. If Scott had said ‘what if we crash the economy and that ruins our healthcare system and then there is another pandemic worse than this one’ then you are roughly on par with the extremeness of the statements.
To the actual question is not your A vs B scenario, it is ‘If there is no vaccine forthcoming then how do we act with this virus.’ That answer automatically opens up a comparison between our current actions and what other avenues you can take. Then you can use your answer for how we live without a vaccine in the future to think about how we should live without a vaccine now, which is a different type of question from ‘what if what we think about this virus now isn’t true and its happens to be worse’. The latter can be rephrased as ‘what if this virus ends up so bad that it is worth literally any cost to deal with it’ which is a form of Pascal’s mugging whose analog in the other direction is ‘what if the economic costs are always worse than the disease’, and not the question that Scott asked.
*I’m sure a very small number of people think the environmental benefits are worth the economic costs, functionally no one in this discussion seems to hold this position.
You are twisting words, rephrasing the statements of the people you disagree with so they fit your preconceptions better, and ignoring their more reasonable arguments in favor of attacking the most extreme one. You are then acting as if your takedown of these rephrased and extreme statements is somehow applicable to all arguments made by “the other side” and that it is enough to prove they used the supposed fallacy you called out. And all so you can shut off discussion of a possibility that is not, on its face, that much more improbable than the one Scott discussed. IF it is more improbable at all.
I find your behaviour rather contrary to the professed virtues of a community espousing the value of Steelmanning.
You accuse me of twisting words when you have clearly not read the OP. The actual OP is a series of what if X, and then Y (conditional of X) and then Z (conditional of Y). I am not attacking one part of the argument, I am attacking the sum of the arguments and the hypothetical outcome.
My understanding is that these two are likely to be correlated, diseases which have short term immunities are harder to create vaccines for.
I don’t think those scenarios are unreasonable; reinfection for coronaviruses in general is not impossible, and we know some recovered patients are left with lung damage and even damages to other organs. Add to that the possibility of different strains of the virus and a lot of those possibilities don’t look so improbable.
Scott may not have been pessimistic enough.
How many 75 year olds would you have to kill in the US to get life expectancy down to 50? What % of over 65 year olds? Back of the envelope calculation you would have to kill 100% of the 60+ population to get life expectancy down to 50, its in that range.
What is implausible here is the chain of things that has to happen for life expectancy to drop that low, and he completely leaves out a ton of steps.
What if there is no immunity after 12 months, and it leaves lasting damage that eventually kills AND locking down in a future year for some reason doesn’t work but locking down this year does, AND there is no other reasonable course of action that can be taken to mitigate the spread in the future.
This is the mugging, the statements taken as a whole boil down to ‘what if exactly the worst combinations of things happen and mitigation is impossible BUT mitigation now is somehow possible and effective’.
The other thing that is unreasonable is that Scott took 1 objection, and the most important objection that ought to be a standard part of all support for lockdowns and the reply was a laundry list of possibilities. Each one of them maybe plausible*, but the response was disproportionate and takes away from Scott’s response.
*some of them weren’t.
Those are reasonable points but 1/4 of common colds are caused by coronavirus. Imagine how many times you’ve gotten the common cold. No vaccine yet. Imagine each time you got a cold you suffer significant damage to the lungs. That may plausibly bring down life expectancy a lot.
IIRC in my high school / college days I got colds a lot. So even if it’s very rare right now that Covid19 kills a young person, they could start accumulating lung damage very early on.
So yeah, you’d have to kill a lot of 70y/o to bring down life expectancy, but we are talking about relatively young people catching COVID19 between 4 times to 10 or more times before their 50s. Some of those later reinfections could be lethal.
Really simple question: Do you think it is impossible to reduce the number of colds you got at that stage in your life through behavioral changes?
My pet peeve: People who cry “Pascal’s mugging” regarding risks that are totally within the realm of possibility. “Permanent damage from COVID is about as likely as superpowerful beings from another dimension trying to extort money from me!”
The OP didn’t just posit permanent lung damage from COVID-19, but a daisy-chained set of worst-case assumptions far more dubious than just the existence of permanent lung damage.
Rolling the dice and having them come up snake-eyes is within the realm of possibility. By the time you get to snake-eyes four times in a row, you’re already at a million-to-one long shot and probably ought not be weighing this theoretical possibility too heavily in your planning.
Reminder that the original Pascal’s Mugging invoked the effective deaths of 3^^^^3 people. Serial risk factors and million-to-one “long” shots are difficult to weigh, but utterly incommensurate with the sort of out-of-context problem the thought experiment was meant to highlight.
And if, on your final roll, you roll thirteen against your opponent’s twelve — because one of your dice broke and came up six and one — they make you a saint.
Sure, but it’s still not a reason to throw out expected value theory.
I don’t see how you can possibly get to a life expectancy of under 50 years by any reasonable version of this scenario. From the CDC, general mortality for 45-55 year olds is 0.4%/year, for 55-65 is 0.9%/year and 65-75 is 2%/year. Even if we assume everyone gets COVID-19, and even if we assume that we assume that all COVID infections are being found by testing (both of which are clearly wrong), our world in data gives rates of 0.4% for 40-50, 1% for 50-60, 2-3% for 60-70% and 5-12% for 70-80%. It’s too bad the age brackets in these sources don’t match, but roughly, we’re talking about increasing total mortality to 1% for 40-50, 2% for 50-60 and 5% for 60-70.
This means that, starting with a population of 40 year olds, 90% of them make it to 50, 74% make it to 60 and 45% to 70. In your world, it is unusual for someone to know all four of their grandparents, but also unusual for them to not know any of them, and the biblical three score and ten becomes a distinguished old age, but not a miracle. This scenario is very bad! Worth spending billions to prevent. But not as bad as you suggest.
I didn’t include the cumulative lung damage scenario, because I had no way to assign a number to it, but it is also absurd to think that everyone would be infected every year, or that the data on the World in Data page is the true fatality rate.
“This article is kind of critical of Dominic Cummings, but the criticism is that he inappropriately pressured scientific bodies to order a UK lockdown ASAP […] In this case he was right and deserves to be celebrated.”
As someone in the UK who followed this story, I must say that I don’t trust this article (or others like it) at all. Boris Johnson, who leans on Cummings as his closest advisor, was an early opponent to the lockdown (he famously espoused the “herd immunity” strategy). At the time that these meetings were taking place, leaks indicated that Cummings thought a lockdown would be “unthinkable” and that the government should pursue herd immunity. Source can be found here.
Once the true toll of Covid became clear (and the British public were shown to be more than 80% in approval for lockdown measures), the government’s slow response became a matter of controversy. Fingers were pointed at Cummings as the one to blame, thanks to his participation in the Sage meetings. It’s only at this point that the new leaks emerged claiming that he actually pushed for the lockdown rather than against it. These leaks are (1) unverifiable, (2) convenient for him, politically speaking, and (3) strange, considering that Boris chose this crucial moment to ignore his advice.
Might be my biases at work, of course. But to me it looks like the second wave of leaks are a bit of well-calculated PR.
Accepting that the first set of leaks are true and revising your opinion of Cummings downwards, while believing that the second set of leaks are false and not revising your opinion of Cummings at all seems like a mistake of the form described by Conservation of Expected Evidence.
I don’t think you can pick and choose which leaks to believe so easily. While it is not impossible that the second set of leaks were deliberately massaged, the same is true of the first set. You should be consistent on how much you trust newspaper leaks and adjust your beliefs in concordance with that.
Oh, I agree. I’m very much basing my assessment on my prior opinion of Cummings, as well as the context of the surrounding decisions of the Boris Johnson government. Someone else might quite reasonably come to a different conclusion on the same evidence. I’m also not revising my opinion on Cummings downwards, admittedly because my opinion of him is already low.
My point is only that these are muddy waters, and it’s not quite as simple as just saying that “[Cummings] was right and deserves to be celebrated.”