I updated this document from April 28 to May 22, 2020, to keep track of select material about COVID-19. Items are listed in reverse order relative to when I examine them (latest updates on top). See also my newer “COVID-19 Updates 2” page and my older “COVID-19 Resources” page started March 24. Unless otherwise specified, many of my figures come from Our World in Data and the CO Dep’t of Public Health.
Lockdowns—Realistic Assumptions: I’ve been surprised by the generally poor quality of arguments on both sides of the lockdown debate (see below). There are exceptions; among the critics, I like the work of Lyman Stone, Jason Brennan and associates, and me. Here I want to expand on what I’ve written before and offer the start of a realistic model for the effects of lockdowns (stay-at-home and shelter-in-place orders). It is obviously not the case that the government orders entirely caused people’s increased social distancing. People started social distancing even before the orders went into effect, and undoubtedly people would have increased their social distancing even had the orders not gone into effect. So I have been surprised by how many people have made the obviously stupid assumption that the lockdowns are entirely responsible for the increased social distancing. At the same time, obviously the lockdown orders had some effect on social distancing; no reasonable person claims that levels of social distancing would have been exactly the same absent the orders. (I suppose someone could argue that social distancing did not slow the spread of the disease, but that also seems obviously wrong.) The right answer, then, must be that the lockdown orders caused some of the increase in social distancing. Getting a good estimate of how much the lockdowns affected social distancing would require some very complicated regression work that is far beyond my abilities. My purpose here is simply to lay out the intellectual framework for such a model. The most obvious effect of lockdowns is that they imposed legal penalties for certain sorts of social interactions. I don’t think anyone would claim that these penalties had no effect on people’s behavior. The lockdown orders also served an informational purpose: In issuing the orders and reporting on them, public officials and journalists helped convey the severity of the pandemic. Of course, at least part of this information could have been conveyed by other means, say by government officials issuing stern advisories rather than orders. So far I’ve reviewed what should be obvious on reflection to any thinking person. Now I want to make a subtler point that may not have occurred to some people. I think the lockdown orders were reciprocally causal with people’s propensity to voluntarily increase their social distancing. How? The very people most likely to voluntarily social distance (more) are the same people most likely to elect governments that imposed lockdown orders, and, in turn, the lockdown orders made these people even more willing to socially distance. I think these sorts of complications explain why dumb models depending on obviously false assumptions render obviously false conclusions and why smart models would be really hard to construct. But maybe someone will give it a real effort.
Lockdowns—Columbia Model: “Lockdown Delays Led to at Least 36,000 More Deaths, Models Find,” the New York Times proclaims (May 21). “At Least 54,000 U.S. Deaths Could Have Been Avoided If Lockdown Had Come Two Weeks Earlier,” Forbes announces (May 21). Okay, let’s look at the paper (posted May 20, lead author Sen Pei) behind the claims. Here is the summary: “We use county-level observations of reported infections and deaths, in conjunction with human mobility data and a metapopulation transmission model, to quantify changes of disease transmission rates in US counties from March 15, 2020 to May 3, 2020. We find significant reductions of the basic reproductive numbers in major metropolitan areas in association with social distancing and other control measures. Counterfactual simulations indicate that, had these same control measures been implemented just 1-2 weeks earlier, a substantial number of cases and deaths could have been averted. Specifically, nationwide,61.6% [95% CI: 54.6%-67.7%] of reported infections and 55.0% [95% CI: 46.1%-62.2%] of reported deaths as of May 3, 2020 could have been avoided if the same control measures had been implemented just one week earlier.” A red flag is that the paper seems to equate “social distancing” with “control measures.” But of course they are not the same thing. People voluntarily socially distanced to a large degree even before the lockdowns, and this social distancing would have increased without the lockdowns. So just assuming that the lockdowns caused the observed social distancing will not do. The paper states, “After March 15, R0 in all six metropolitan areas [New York, New Orleans, Los Angeles, Chicago, Boston and Miami] decreases substantially in association with the implementation of social-distancing policies and practices.” So here, as before, the paper expressly calls the relationship an “association.” Can we conclude from this that the the government controls entirely caused the observed social distancing? Of course not. Can we conclude that, had government imposed the same controls earlier, as the authors imagine, that the same levels of social distancing would have been observed? Of course not. Indeed, the paper explicitly concedes that such conclusions are unwarranted: “We note these counterfactual experiments are based on idealized hypothetical assumptions. . . . Public compliance with social distancing rules may also lag due to sub-optimal awareness of infection risk.” No kidding. But try telling that to the New York Times or Forbes. * Jacob Sullum also has an article about this.
Lockdowns—Briggs: Joe Nocera asks whether lockdowns have been worth the costs. He offers an interesting review of the H3N2 “Hong Kong flu.” But his case against the lockdowns is weak. He quotes . . . Jeffrey Tucker, who has an interesting history of the origins of lockdowns (drawn largely from the New York Times) but who is also an anarchist-libertarian ideologue. He also quotes William Briggs, a statistician. I’ll get to his paper in a bit. Nocera, drawing from Briggs, writes, “As of May 12, the U.S. had 237 deaths per million people. Taiwan, a no-lockdown country, had 0.3 deaths per million.” But that’s obviously silly. No one claims that lockdowns are the only possible government response that can work. Obviously Taiwan took other extraordinary measures, making lockdowns unnecessary. Nocera compares Sweden to . . . Belgium and Ethiopia. Again, that’s silly. No one thinks disease spread would be the same in different countries but for lockdowns. For serious critiques of lockdowns see below. This is not one of them. * Briggs confidently proclaims (May 14), “There Is No Evidence Lockdowns Saved Lives.” Yes, he compares Taiwan to Sweden, both “no lockdown” countries with radically different results. Which is a dumb comparison. We can tell Briggs is on the wrong track when he writes, “If lockdowns worked as advertised, then we would not expect to see such enormous variability in the reported death rates.” Wrong. Again, no serious person thinks that lockdowns completely explain differences in disease progression. Briggs also compares Sweden to the UK. But the issue there is that the UK waited a long time before getting serious about the illness. The relevant question here is, if the UK had imposed a lockdown earlier, or if Sweden had imposed a lockdown early on, would those countries have suffered fewer deaths? But Briggs doesn’t consider the relevant questions. (Incidentally, Briggs is also openly bigoted against transgendered people.) Briggs’s May 18 follow-up is nearly as vacuous, although he does offer a few reasons to be skeptical of certain claims supporting lockdowns. The quality of Briggs’s writing is so poor that I was surprised to see he has a 2016 book out via Springer about statistics. The bio line with Springer says Briggs “is Adjunct Professor of Statistics at Cornell University[, h]aving earned both his PhD in Statistics and MSc in Atmospheric Physics from Cornell University.” In 2017, Briggs reported that he’d been “fired” by Cornell. Incidentally, Briggs has written articles for the Independent Institute and for the Heartland Institute, where he critiques climate science.
U.S. Disease Spread: For what it’s worth, the new (May 21) Imperial College report states, “We predict that deaths over the next two-month period could exceed current cumulative deaths by greater than two-fold.” That would be a disaster. But what is this worth? Here is the rest of the sentence: “. . . if the relationship between mobility and transmission remains unchanged.” Of course there is no reason to assume that and good reason to think the relationship will change dramatically as people modify their behaviors. Moreover, “We do not address the potential effect of additional behavioural changes or interventions, such as increased mask-wearing or testing and tracing strategies.” But the report seems to be a spur to action rather than an actual prediction: “Our results suggest that factors modulating transmission such as rapid testing, contact tracing and behavioural precautions are crucial to offset the rise of transmission associated with loosening of social distancing.” Fair enough. Here’s the full pdf. A couple of Colorado-specific details: This report estimates that the state’s effective reproduction rate is over 1, so bad news. The report also thinks 4.6% of Coloradans have been infected (range of 3.1% to 7.3%), higher than state estimates; and that Colorado as of May 17 has 47,000 “currently infectious individuals” (range of 15K to 110K).
Sensationalism: Here is Yahoo news: “According to a new Yahoo News/YouGov poll, 44 percent of Republicans believe that Bill Gates is plotting to use a mass COVID-19 vaccination campaign as a pretext to implant microchips in billions of people and monitor their movements.” Now, I have no doubt that a few people believe such looney-tunes conspiracy theories. But 44% of Republicans? I Tweeted my alternate theory: “Many Republicans were intentionally trolling pollsters asking obviously idiotic questions.”
Social Distancing: Discouraging people from being outside may encourage them to move social events to more-dangerous indoor settings (summarizing Julia Marcus).
Testing—Capacity: Alex Tabarrok writes, “What is wrong with our country? Test capacity not being used because nobody can do anything without the right form. It’s not even a government form.” He refers to a New York Times article by Katie Thomas, who explains that new testing facilities found few takers because “bureaucratic hurdles of quickly switching to a new lab were just too high.” Thomas blames the lack of a “national laboratory system”; of course I am instead tempted to look for ways that government hampered market responses. The broader point remains: U.S. labs already can run many more lab results than they are running. But the testing hasn’t scaled up.
Testing: I wasn’t terribly surprised to hear that some states are mixing the results of PCR and antibody tests. I was surprised to hear the CDC is doing that. Pennsylvania, Texas, Georgia, and Vermont also as mixing test results, reports the Atlantic, and Virginia and Maine were doing that. * “Texas is now breaking out antibody test data.” * In related news, “Only about 60% of states report covid hospitalizations.” * My question exactly: “Hospitals are reporting all COVID-19 testing but we also have to do a lot of additional testing—for discharge to LTCF [?], clearing patients from iso, etc. Sometimes patients can be tested a handful of times during their stay—are all of these counted for surveillance?” * What should be news is that such practices were not universal early on: “After identification of two cases of COVID-19 in an SNF in Los Angeles, universal, serial reverse transcription–polymerase chain reaction (RT-PCR) testing of residents and staff members aided in rapid identification of additional cases and isolation and cohorting of these residents and interruption of transmission in the facility.”
Treatments: “Plasma transfusions may offer benefit to some patients.”
New York: “More than 4,500 recovering coronavirus patients were sent to New York’s already vulnerable nursing homes under a controversial state directive,” reports the AP.
Lockdown Regulations: I’m glad to see Pacific Legal taking up the Cordairs’ efforts to reopen their art gallery. “The Cordairs want to reopen their 3,000-square-foot gallery to six customers at a time using state-recommended social-distancing and sanitation protocols—just as many other businesses are (or will soon be) allowed to do. But because they are considered a ‘Stage 3’ business under the state’s reopening plans, they must stay shuttered indefinitely.”
Herd Immunity: Bryan Caplan points out (as I have noted before) that the level of infection required for herd immunity varies with effective reproduction rate, which people can purposely drive down through changed behavior. Wikipedia, Caplan notes, thinks the COVID-19 herd immunity threshhold is somewhere between 29% and 74% of the population. Well, that’s quite a range! And, anyway, most regions are still at only a fraction of infections even of the lower thresshold.
Colorado: Kyle Clark reports that numerous restaurants intend to open in violation of health orders. I replied, “Has anyone tried checking in with the restaurants’ liability insurance companies? I can’t imagine the insurance lawyers are too happy about this. (Actually my guess is that the policies explicitly exclude such activity from coverage, but I’m not sure.)” * El Paso County Commissioner Longinos Gonzalez is among those critical of the state’s health orders. His main complaint seems to be that the orders were not subject to proper review. * “Denver Zoo Submits Request To Operate With One-Way Foot Traffic.” Seems reasonable to me. * Colorado’s Department of Public Health and the Colorado School of Public Health estimate that 167,000 Coloradans have had COVID-19, or 2.9% of the popuation. We’re far away from herd immunity. * Ed Sealover reports, “While [Governor Polis] prepares to announce a reopening date for restaurants, he is looking seriously at not allowing brewery, winery and distillery taprooms to reopen to the public.” * “USPS Defies [Denver’s] Orders To Close Denver Sorting Facility That Handles Mail For All Of Colorado.”
Brazil: As Brazil’s authorities dig mass graves, one nurse calls the disease “he worst thing we have ever faced in our professional lives.” The country has surpassed 20,000 deaths, and daily deaths are on an upward trajectory.
General: Amesh Adalja has a nice discussion with Amy Peikoff. Adalja continues to be skeptical that people generally, and especially young children, will use homemade masks in an effective way. He notes, and I personally have witnessed this, that some people will just touch their masks frequently, probably rendering masks worse than useless. As I keep saying, masks aren’t magic, and they don’t kill viruses on contact. That said, if I go into public I intend to wear a mask (an N95 if those become widely available, otherwise a homemade one), because I won’t be an idiot about it. Adalja is unsure about the prevalence of asymptomatic spread. Offhand it seems to me that severity of symptoms probably correlates pretty highly with contagiousness. What about children? Adalja speculates that children may be less susceptible to the virus because they have more cross-immunity from other, cold-causing coronaviruses. And he mentions what I’ve heard before, that children may be less prone to having overactive immune responses that seem to cause trouble for some adults. Adalja is skeptical that vaccines for other diseases help children with COVID-19, but he says such theories should be run down. He says that people on immune suppressing drugs, say for arthritis, might be more susceptible to a serious coronavirus infection. I found it interesting that Adalja too says that actually living through a serious pandemic, something he has long prepared for, is a “surreal” experience. I’ve certainly felt that it’s surreal. He comments on the difference between the well-devised plans and the “fumbled” implementation by government. “We really messed it up,” he summarizes. I certainly don’t include him in that “we.”
Africa: “In West Africa contact tracing was crucial in bringing the 2014-2015 Ebola outbreak to a close.”
Treatments: “A team of Canadian scientists believes it has found strong strains of cannabis that could help prevent and then treat coronavirus infections.” Dude.
Transmissibility: A May 19 Science article (Kai Kupferschmidt) reiterates what we already knew: “Some COVID-19 patients infect many others, whereas most don’t spread the virus at all.” The article discusses superspreading events and describes “the dispersion factor (k), which describes how much a disease clusters. The lower k is, the more transmission comes from a small number of people.” Adam Kucharski of the London School of Hygiene & Tropical Medicine says, “Probably about 10% of cases lead to 80% of the spread.” Jamie Lloyd-Smith of the University of California, Los Angeles, says, “Some people infect many others and others don’t spread the disease at all. In fact, the latter is the norm.” Both a person’s biology and a person’s behavior can affect how contagious the person is, the article notes. The context of social interaction also matters a lot.
Testing: On May 8 the New York Times reported that the FDA approved an at-home saliva test kit “developed by a Rutgers University laboratory, called RUCDR Infinite Biologics, in partnership with Spectrum Solutions and Accurate Diagnostic Labs.” * Rutgers issued an April 13 release claiming “FDA approval” for its saliva test. * The FDA issued its own release about the test on May 8, noting the “test remains prescription only.” * On May 15 the NYT reported that the FDA stopped a “coronavirus testing program backed by Bill Gates” for the Seattle area.” This article also discusses the Seattle Flu Study, saying “researchers there had struggled to get government approval to test those old samples for the coronavirus and report the results. By the end of February, those researchers ended up doing some testing anyway, discovered the first case of community transmission.” Although the details are unclear (to me), apparently part of the problem is the FDA got nervous about researchers sharing test results with patients (directly or via the pateints’ doctors). * Bill Gates wrote a May 12 blog post about the Seattle program, which involves self-administered nasal swabs.
Sweden: Kristian Andersen summarizes, “A lot of government reports from European countries on seroprevalence to SARS-CoV-2 this week and they all show the same—it’s low. Spain ~5%, Italy ~5%, Sweden ~5%, Denmark ~1%, Norway < 1%.” I was most curious about the Swedish results. Anderson cites a May 20 document in Swedish. Google Translate renders this, “A total of 7.3 percent of the blood samples collected from people in Stockholm were positive in the antibody study.” That’s considerably lower than previous estimates I’ve seen. CNN has an article about this.
Public Opinion: Most Americans favor masks in public. * Ed Yong has an interesting piece about how the pandemic plays out very differently in different regions of the U.S. I’ve experienced this within Colorado: Some people that I know in counties with low incidence of the disease have a very different attitude than I have, living in the metro area. Yong quotes medical anthropologist Martha Lincoln about the problem of the “disparity in spectacle,” created by media covering the few reveling in social bliss while everyone else stays home. Still: “Polls have also shown that pandemic partisanship is narrowing, with Democrats and Republicans more united in how seriously they view the threat.” Sociologist Beth Redbird says, “70 to 75 percent of people support most social-distancing measures.”
Collateral Damage: A May 19 letter by Simone Gold and hundreds of other doctors raise the alarm about the costs of the “national shutdown.” It is a now-familiar list of problems: Fewer cancer screenings, less dental work (which can increase heart disease), delayed “elective” procedures leading to long-term health problems, less general health screening and care; more stress and unemployment leading to more child abuse, alcoholism, and suicide.
Colorado—Excess Deaths: Good report from the Colorado Sun: “In 2019, 6,761 people died during March and April in Colorado. This year, that number increased by at least 17% with a total of 8,190 Coloradans dying in March and April.” That’s a difference of 1,429. Yet “only 696 people in those months are recorded as having died from COVID-19.” So 733 of the “excess deaths” have not (yet) been attributed to COVID-19. Plus we know car crashes are down. The authors doubt many of those extra deaths are due to suicide and drug overdoses. I suspect that quite a few of them are due to other untreated or undertreated diseases.
Colorado—Modeling: How has Colorado modeling held up? On March 27, Governor Polis held a media conference in which he presented some of the results of state models. He predicted that, with an R0 of 4, deaths by June 1 would range from 11,500 with 60% social distancing to 33,200 with no additional social distancing. With an R0 of 3, deaths would range from 400 with 60% social distancing to 23,000 with none. Seems to me that modeling has held up pretty well. Our actual death toll as of May 21 is 1,310 “among cases” and 1,062 “due to COVID-19.”
Colorado—Meat Packing Plants: Rachel Maddow has been highly critical of the JBS meat packing plant in Greeley in two segments, May 20 and May 6. See also Raw Story‘s summary of the May 20 report and Westword‘s summary of the May 6 report. The upshot is that Maddow thinks the plant has not adequately tested employees for the virus.
Colorado: A few people in El Paso County, Colorado, are refusing to cooperate with contact tracing. El Paso County Coroner Dr. Leon Kelly told the Colorado Springs Independent, “We have had increasing resistance from individual who tested positive to cooperate with contact tracing. . . . [W]e’ve had multiple individuals who have refused to answer questions—where they could have gotten it from and who else could be at risk. This, unfortunately, has been turned into a political issue.” *Although according to the state drive-in movie theaters can open (see below), in practice at least one drive-in says it cannot operate under regional rules. 88 Drive-In reports that, according to the Tri-County Health Department, drive-ins can operate only if no one leaves their cars and if the restrooms remain closed. Obviously that is ridiculous. Update (May 22): Tri-County clarifies drive-ins can open with restrooms and concessions. * Governor Polis made the excellent point that states are neither totally “open” nor totally “closed.” There’s no place in the country where nightclubs have thousands of people” and “no states where grocery stores are closed,” he told MSNBC.
Health Effects: A May 19 paper (lead Matthew Cummings) looks at hospitalizations in New York. 22% of patients in the period were critically ill, and those patients did poorly. The paper also looks at characteristics of patients (generally older and with health problems).
Lockdowns—Brennan: A new paper by Jason Brennan, Chris Suprenant, and Eric Winsberg argues that lockdowns “have not been accompanied by the epistemic practices morally required for their adoption or continuation. While in theory, lockdowns can be justified, governments did not meet and have not yet met their justificatory burdens.” The paper uses global examples but applies to stay-at-home and shelter-in-place orders in various U.S. states. The authors “argue that states relied upon bad data and flawed models, and they lacked the other kinds of evidence they would need to justify lockdowns.” The paper starts out by reviewing the importance of individual liberty in liberal political philosophies. Liberalism holds, summarize the authors, “that all restrictions on freedom must be justified,” “that freedom cannot easily be overridden or silenced in the name of the common good,” and “that the justifications governments offer for overriding basic rights must be grounded in and appeal to public reasons and information that is appropriately available to all citizens.” Hovever, note the authors, “even libertarian liberals, despite their anti-statism, often defend restrictions on basic liberties, particularly in the name of preventing harm.” But this imposes strong responsibilities to make and present a reasoned case for the restrictions. “Policies must be justifiable to those citizens in light of certain publicly shared values and publicly available evidence which all reasonable citizens can accept.” To play devil’s advocate, did not governments meet this burden here? We all know that SARS-CoV-2 is a real and deadly virus, that it spreads person-to-person through respiratory function, that it caused a global pandemic, that the nature of such infections is that they can spread exponentially, that limiting social interaction reduces the effective rate of spread, and that governments faced emergency conditions creating a pressing need for quick action. Every public opinion poll I’ve seen expresses widespread support for the lockdowns. So didn’t governments meet their epistemic burdens? The authors summarize their response: “The quality of the data and models used by officials was poor,” and “the decisions were extremely high stakes, imposing significant harms and costs upon people everywhere, especially those in extreme poverty.” So the crux of the argument is that the “data and models” were too poor in quality to justify the lockdowns. The authors’ dive into the epidemiological modeling is really interesting; here I’ll review only part of their discussion. They cite a paper (lead author Christopher Avery) on this topic. Here’s how they summarize Avery’s take on the London Imperial College model: It fails “to account for heterogeneity in degree of viral exposure, fail[s] to account for endogenous behavioral changes (such as that people will self-isolate or reduce their contact with others as the disease spreads), [lacks] parameters for hospital capacity, and [lacks] parameters for underlying comorbidities.” The model therefore failed to correctly anticipate disease surge given restrictions. Moreover, the authors say, people who adapted the model to Sweden predicted many more deaths than actually occurred. Beyond the models, the authors note, there no good evidence that lockdowns have worked in the past. They criticize Andrew Friedson’s paper (mentioned below) on the grounds that it “counts drops in deaths five days after California’s closing as evidence that lockdowns work. Since the virus takes longer than that to incubate, this drop could not have been caused by the lockdowns.” More generally, the authors argue, epidemiologists, often faced with making educated guesses, tend to overestimate the severity of a disease outbreak, as they have done repeatedly. For example, the authors relate, Neil Ferguson radically overestimated the death toll of Mad Cow Disease and bird flu. Still, the authors concede, “it might be appropriate, at the beginning of a potential catastrophe, for policymakers to adopt a very cautious stance” in “the very short term” as they immediately begin to acquire the relevant sort of evidence to make better decisions. An obvious way to get more good information would have been to test more, and especially to do randomized testing, the authors note. Again, the authors point out, they are not necessarily arguing against the lockdowns; they are saying the lockdowns were not properly justified. Then the authors turn to weighing the very high costs of the lockdowns before concluding, “The models and data used in support of lockdowns were poor. There was not sufficient evidence to justify lockdowns over other less restrictive policies.”
Lockdowns—Wittkowski: On April 13, Rockefeller University put out an announcement distancing itself from Knut Wittkowski: “The opinions that have been expressed by Knut Wittkowski, discouraging social distancing in order to hasten the development of herd immunity to the novel coronavirus, do not represent the views of The Rockefeller University, its leadership, or its faculty. Wittkowski was previously employed by Rockefeller as a biostatistician. He has never held the title of professor at Rockefeller.” * I heard of him, and immediately became skeptical of his claims, because he is cited by various critics of lockdowns whom I distrust. To be clear, I am a critic of lockdowns, and I do trust some critics of lockdowns. But many are unreliable. For example, the libertarian anarchist Jeffrey Tucker favorably quotes Wittkowski. Fox News calls him an “renowned epidemiologist” (even though none of the actual epidemiologists I follow thinks highly of him). I think here’s the main difference: I am skeptical of lockdowns because I think people voluntarily socially distanced anyway, which is good; Wittkowski opposes lockdowns because he opposes social distancing among the general public and wants to reach herd immunity. I increasingly think herd immunity is a really bad strategy. * On May 15 Spiked ran an interview with Wittkowski. He explicitly says that COVID-19 is not dangerous, “unless you have age-related severe comorbidities.” Obviously that’s bullshit. The risks are a lot higher for older people and for people with other health problems, but the disease has also seriously harmed and killed young and otherwise healthy people. Anyone who would take such a cavalier attitude toward the disease automatically deserves entry into the “crank” category. He says, “We could open up again, and forget the whole thing,” which again is obvious nonsense. He stupidly cites the decline of disease spread in various regions while ignoring the measures that led to that outcome. He does advocate cocooning the elderly; a serious strategy along those lines involves frequent testing. He says, “children and young adults do not end up in hospitals” from the disease, which is a lie. He says, “All the studies that have been done have shown that we already have at least 25 per cent of the population who are immune,” which is also a lie. Put bluntly, Wittkowski is a dishonest fool, and no one who quotes him except in criticism should be taken seriously.
Lockdowns—Consequences: Surprise, surprise: Lockdowns were enfroced in a racially unequal manner, at least in New York.
Lockdowns: Elaine He writes for Bloomberg, “There’s little correlation between the severity of a nation’s restrictions and whether it managed to curb excess fatalities.” But this is beside the point. No one things severity of restrictions (or degree of social distancing) per se is what matters; early changes are much more important than later changes.
Germany: It’s “learning a tough lesson: The way out [of the lockdown] is much harder than the way in” (Anna Sauerbrey). Here’s the requirement on regions as they reopen: “If the number of new cases rises above 50 in 100,000 inhabitants across seven days in an area, the local authorities must reinstall restrictions.” Meanwhile, obviously, “the economy is in disarray.” And thousands of “far-right” protesters have taken to the streets.
Disease Spread: Lyman Stone lays out a terrifying scenario in which the disease rests for the Summer but then comes back for a ferocious Second Wave. He recommends that we ramp up (drum roll) contact isolation. * Erik Brynjolfsson writes, “More infected people means more viruses. More viruses means more mutations. That can mean more virulent forms of Coronavirus.” I’m tempted to respond, but can’t mutations also mean less-virulent forms of the virus? Yet Brynjolfsson points to an April 29 paper (lead Bette Korber), updated May 5 (pdf), which states, “The mutation Spike D614G is of urgent concern; it began spreading in Europe in early February, and when introduced to new regions it rapidly becomes the dominant form. Also, we present evidence of recombination between locally circulating strains, indicative of multiple strain infections. These finding have important implications for SARS-CoV-2 transmission, pathogenesis and immune interventions.” So the idea is that one variant of the virus seems to be more transmissible. The biology is beyond me, I’m afraid, so I have no idea what the relationship between transmissibility and fatality (per case and total) here might be.
Infection Fatality Ratio: A May 18 revised paper (lead Gideon Meyerowitz-Katz) estimates an IFR of 0.75% (or between 0.49% and 1.01%). Another paper, posted May 19, by John Ioannidis, estimates a much lower IFR of 0.02% to 0.4%. Meyerowitz-Katz offers some reasons to doubt Ioannidis’s findings. One concern is the lower estimates rely on results from blood donors, who “are by definition healthy.” He continues, “If we exclude [the] potentially misleading numbers, the lowest IFR estimate immediately jumps from 0.04% to 0.18%.” Plus, he adds, the lower estimates are inconsistent with the raw death rates coming out of places such as New York City, even compared to the total population. * By way of background, Ioannidis also was involved in the much-derided Santa Clara County study, which turned out to have a very biased sample. Natalie Dean is among those critical of the Santa Clara paper and of the newer paper.
History: Lymon Stone (who has been on a Twitter tear lately) also discusses the “1793 Yellow Fever outbreak in Philadelphia.” Here’s part of what he writes, “The reason Philadelphia ultimately beat yellow fever was they invested in isolated quarantine sites for incoming ships, carefully studied and documented outbreaks, invested in water management projects which incidentally reduced mosquito breeding areas, etc. But in New Orleans and the south generally, the low quality government institutions, the callous disregard for the lives of a large share of the population, greater poverty generally, and resistance to public health measures led to a CENTURY of yellow fever outbreaks.”
Regulations: Walter Olsen lays out a variety of ways that businesses trying to comply with emergency safety regulations or adopt their own safety measures could run afoul of the Americans with Disabilities Act.”
Mental Health: Gena Gorlin worries that viewing the pandemic from the framework of Maslow’s Hierarchy of Needs is a problem: “By implying that our physical needs are more ‘basic’ and ‘essential’ than our emotional, intellectual, and spiritual needs, it trivializes the devastating mental health effects of this pandemic.” She further suggests that the right mental attitude involves fighting to overcome challenges rather than passively accepting the loss of “nonessential” values.
Sweden: Politico suggests Sweden is in the same boat economically as its neighbors, but the only actual evidence the article presents undermines that claim: “Recent data showed the economic slowdown in Sweden in the first three months of 2020 was less extreme than elsewhere in Europe—a contraction of 0.3 percent versus 3.8 percent in the eurozone.” To me, what is most interesting about the article is that it reinforces that Swedes dramatically reduced their social interactions even absent mandates. Of course, Sweden has sustain a higher death toll relative to its immediate neighbors, and time will tell the relative damage to its economy.
Masks: I was surpised to hear that carbon dioxide really is an issue with masks, but only with N95 masks. “There is data, however, that prolonged use of an N95 mask can increase blood CO2 levels, and therefore we do not recommend people wear N95 masks for a prolonged period of time,” says Amesh Adalja. I would totally wear an N95 in public for short periods of time, though, if enough were available for public purchase.
Colorado: Yesterday, citing a local May 18 KDVR story, I Tweeted, “Why in the bloody hell are drive-in movie theaters in Colorado closed?” Someone asked about restrooms. I noted, “I think that’s a manageable problem. As has been pointed out to me, bathrooms in grocery stores and big-box home stores remain open.” Governor Jared Polis replied, “Found out about it, got it fixed.” He pointed to a new story (May 19), “Gov. Polis allows drive-in theaters to reopen following FOX31 story highlighting ambiguous health orders.” * Anna Brown points out that many pandemic-era practices are likely to stay around, such as more to-go service and more telework. * Jennifer Hulan discusses the difficulty of trying to keep a restaurant alive in these times. * “Coronavirus deaths at Colorado nursing homes, senior facilities reach 711.” Outbreaks also are reported at various fast-food restaurants, Home Depot stores, and Denver jails. * Lauren Boebert, whose restaurant was shut down even after seating guests outside at well-spaced tables, “Says Grill Closed for Doing What Polis Wants.” It’s a fair criticism. Her practices match up perfectly with what Polis has described as idea.
Good Actors: “Alaskan man makes 14-hour boat trips to Costco to keep his small town fed.”
Bad Actors: “Man told to wear mask shoots Waffle House cook in Aurora [Colorado], police say.” The victim survived; the (alleged) perp is being charged with attempted first-degree murder. Crazy. * Apparently someone is driving around Colorado with an anti-gay message on his truck directed at the governor. * Some people are spreading imagery equating mask requirements to enslavement.
Vaccines: Some skepticism about the early Moderna results.
Lockdowns: In my column today, I offer the basic reasons to think that lockdowns (stay-at-home and shelter-in-place orders) didn’t have the big effects their supporters claim. Basically, voluntary social distancing was a big deal, and also superspreader events are disproportionately important. I briefly outline what government should have done instead (the usual). * Mother Jones breathlessly proclaims: “Shelter-in-Place Orders Saved Nearly 250,000 Lives.” That claim comes from the Urban Health Collaborative, which draws on the March 25 methodology of Nicholas Kristof and Stuart Thompson. But that article looks at social distancing, not the effects of stay-in-place orders and the like. So this is a neat trick: Assume that the only thing that affects social distancing is government orders, and voila, those orders save massive numbers of lives.
Herd Immunity: Amy Rogers lays out the basic case for making herd immunity an intentional goal. * I used to be more favorable to the idea than I am now, largely because I think only a small fraction of the U.S. has already been infected, so reaching herd immunity probably would be extremely painful. However, I again point out that, if we’re headed for herd immunity anyway, then creating a program of variolation would dramatically mitigate the damage of getting there. I think there are two main reasons to try to squash the disease (keep averge effective reproduction rate under 1). First, if we reasonably expect a vaccine within the next year or two, and I do expect one, we should just wait for that. Second, if we think that we’ll face a pretty steady wave of future pandemics, then we’d want to build a mass-testing capability anyway, so we might as well do it now. We should also realize that aiming for herd immunity would not immediately open up the economy, either. We’d still have to worry about the most-vulnerable, and even the least-vulnerable would be averse to getting the damn virus. And of course reaching herd immunity does not mean that the virus goes away; it means that it is continually with us at low levels of transmission. So herd immunity is hardly an economic panacea.
Quarantine—Stone: Lyman Stone is back with an op-ed in the Washington Post. He notes, “Many places, including South Korea and Hong Kong, have avoided lockdowns entirely and are now returning to something like normal conditions.” The key to this success is “contact isolation,” which “is more effective than lockdowns and also less economically disruptive.” Here’s the essential plan: “Anytime someone tests positive—regardless of symptoms—their close contacts are identified. The person with the positive test result and all of those contacts are then required to move temporarily into a government-run, hygienic, isolated environment.” You can see why this would rub many Americans the wrong way. I continue to think that in-home isolation can work much better than Stone assumes. I don’t even think this would have to be mandatory: I think most people want to keep themselves and others safe. However, I’m not against legal penalties for non-compliance per se. Stone suggests fines. I’m intrigued by the idea of government paying people to stay in isolation (something that could be means-tested). I think it’s probably a good idea for government to set up or fund quarantine facilities for people who prefer them to isolating at home.
Social Distancing: This is clever, from Ajay Shenoy: “Our new paper exploits rainfall shocks on the weekend before a county’s statewide lockdown. Rainy counties have more early social distancing, and fewer subsequent cases/deaths.” Here’s the paper. * Elsewhere, Shenoy writes, “The orders certainly have an effect, but people start staying home long before the order comes down.”
Contact Tracing: “You Don’t Need Invasive Tech for Successful Contact Tracing,” writes Caroline Chen. * I Tweeted, “Seems to me that scammers could cold-call people to ask them for personal information under cover of ‘contact tracing.’ So it seems like ID verification will be important. (Maybe: ‘Call this verified number for your interview.’)”
History: “Why Did the 1918 Flu Kill So Many Otherwise Healthy Young Adults?” Ruth Craig asks (2017). Here’s the key part of her answer: “Exposure to an influenza virus at a young age increases resistance to a subsequent infection with the same or a similar virus. On the flip side, a person who is a child around the time of a pandemic may not be resistant to other, dissimilar viruses.” In fact, goes the theory, resistance to one sort of virus actually can make a person more susceptible to other sorts of viruses by generating a “dysfunctional response.” Yikes!
Immunity: Pretty much what we already knew: “Covid Patients Testing Positive After Recovery Aren’t Infectious, Study Shows. They’re shedding only dead virus.” * “Survivors of SARS1 from 2003 retain neutralizing antibody 9-17 years later.”
Russia: “Russia’s Coronavirus Outbreak Became One of the World’s Worst.” For what it’s worth, Our World in Data has Russia’s daily deaths in the range of 100 recently. But I trust Russia’s official numbers even less than I trust China’s. (I haven’t looked into exactly where OWD gets this data.)
Colorado: A photo of an obviously-crowded beach at Cherry Creek State Park yesterday does not fill me with confidence that everyone continues to take the disease seriously. * “For the 10th consecutive day, Colorado’s positivity rate has stayed below 10%.” And this is true despite no serious increase in testing. * “Colorado lawmakers and the public will not be required to wear masks . . . at the Capitol.” This seems really stupid to me.
Exit Strategies: Marc Lipsitch recently discussed COVID-19 with Rob Wiblin of 80,000 hours. One source discussed is Harvard’s COVID-19 Path Forward. Lipsitch also wrote, “For the sake of both science and action in the COVID-19 pandemic, we need collaboration among specialists, not sects.” On the program, he says, “There’s no approach that makes sense that doesn’t involve considerably more testing.” * Kevin Bryan writes, “Our basic finding is that the rate of Covid innovation is incredibly rapid, but competitive forces are pushing that research in a very short-term direction.”
Testing: Paul Romer discussed his proposal for mass-testing with Russ Roberts (released May 13). He likes saliva tests, which the FDA seriously impeded. The pair have an interesting discussion about civil liberties. Although that’s an important discussion, I just don’t think that this is much of a problem when it comes to testing and isolation. Almost all people want to know if they are sick and want to avoid infecting others. As Romer points out, just making the tests available to anyone who wants one probably would solve the problem of keeping the average reproduction rate under 1. Romer says (minute 42:40) that the FDA is willing to defer to the states if the states are willing to take the lead on testing. I say states should go for it. Another Romer idea is to create a federal billion-dollar prize for the first lab that can process ten million tests per day. Romer points out that building a testing infrastructure also will protect us from future pandemics. * Romer argues that it is important to make sure than a vaccine is safe. A vaccine that killed people with side-effects could undermine the general consensus around getting vaccines, he worries. * Mike Lee writes, “As states begin to safely re-open and Americans return to work, I cosponsored the Right to Test Act – legislation to let states approve and distribute diagnostic tests when the state or federal government has declared a public health emergency.”
Regulations: Timothy Sandefur argues an orders from Pima County, Arizona, impose “imposes arbitrary and unenforceable requirements on local businesses.” * “Colorado drive-in movie theaters are reopening illegally, according to state.” * “Occupational Licensing, Zoning, And Other Regulations Will Delay Recovery From COVID-19.”
Lockdowns and the Law: Jon Hersey offers some detail about the Wisconsin Supreme Court’s ruling throwing out the state’s emergency order. * Meanwhile, “Oregon Supreme Court puts hold on Baker County judge’s ruling declaring governor’s coronavirus orders ‘null and void.'”
Mitigation: Apparently sunlight does kill coronaviruses pretty quickly. A Washington Post article and earlier article reference lab results from the Department of Homeland Security. The upshot is that direct sunlight can cut the halflife of the virus from 18 hours to a matter of minutes, depending on conditions.
Economic Fallout: “Thousands Line Up Outside Queens Food Pantry Hours Before Opening.” * “Over 4 million Americans are now skipping their mortgage payments.” * “For Landlords, No Rent Means Economic Worries Of Their Own.”
Bad Actors: “America’s far right is energised by covid-19 lockdowns.” This is so stupid. Either the lockdowns had a big effect on social distancing, in which case they saved many lives, or they didn’t have a big effect (as I think), meaning they didn’t do much harm to the economy.
Today I’m finally getting to part of my backlog of interesting links, so today’s comments mix new and slightly-older news.
China: “Some 108 million people in China’s northeast region are being plunged back under lockdown conditions as a new and growing cluster of infections causes a backslide in the nation’s return to normal.” This dance is hard to learn.
Liability: How does government signal to businesses that they won’t be sued out of existence if they reopen and someone gets sick, while at the same time encouraging businesses to take reasonable safety precautions? Offhand I like the idea of Tyler Cowen and Trace Mitchell to “limit liability in the short term to cases of recklessness.” They want, for example, to ban open buffets at restaurants (they want an outright ban of these, which strikes me as overkill), but enable restaurants to open with appropriate precautions.
Quarantine: Lyman Stone argues that the use of quarantine (of the likely sick) has a long history in the U.S. “In response to an epidemic [in 1793], the Founding Fathers imposed a cordon sanitaire around Philadelphia and established centralized quarantine at a designated fever hospital site,” he writes. “George Washington was personally present at the start of this, though he left the city early on. There’s no record of him being at all opposed to these measures. Of course, these measures were misguided: Yellow Fever is spread by mosquitoes, not person-to-person, so none of these measures had any effect. The outbreak is so sad in part because it was so misunderstood.” * Tyler Cowen has (sort of) come out against central quarantines, and Stone challenges him. I agree with Cowen here: “If a family wishes to stick together and care for each other, it is not the province of the government to tell them otherwise.” To me this is a tangential issue. Generally, where people isolate is irrelevant from a disease-spread standpoint. Contra Stone, I think governments easily could enforce serious at-home quarantines. However, people do need to be aware that the virus spreads very readily among people with prolongued contact. Bluntly, if I had the disease, I’d rather leave my house so my wife didn’t get it, and I think many people would respond that way. Cowen appears to argue against any sort of enforced quarantine, which I think is obviously wrong on philosophic grounds.
Disease Prevalence: Even hard-hit France appears to have reached only 4.4% immunity. * Lyman Stone argues that, in the U.S., “We are nowhere close to herd immunity no matter what creative math you prefer about heterogenous agents. The cost of trying to achieve herd immunity would be incredibly high. It’s a dumb strategy.” He again calls for central quarantine for the infected and their contacts, with targetted testing. * Hard-hit Spain shows only 5% prevalence of antibodies with an infection fatality rate of perhaps 1.1%. * Carl Bergstrom is severely skeptical of claims of high disease prevalence in the UK.
Testing: Paul Romer airs his frustrations that the U.S. has not much ramped up its testing. We still don’t even have adequate testing to protect nursing homes.
Japan: “Unlike governments elsewhere, Japan’s leaders have no legal power to enforce a lockdown. While local governors can call on businesses to stay closed and suggest people stay at home, there are no punishments if they choose not to do so. Despite this, mobility data has shown a striking drop in public movement.”
Schools: Lyman Stone makes an interesting argument that a benefit of school closures is that they induce more adults to stay home with their kids. In other words, possibly, the main benefit of school closures is not that they stop children from spreading disease, but that they stop adults from interacting as much. That doesn’t strike me as a very good reason, though.
Hong Kong: Will Ripley describes the intense precautions Hong Kong is taking with travelers, including use of spit tests.
Immunity: A May 7 paper (lead author Joshua Weitz) argues for leaning on “shield immunity.” In the paper’s wonkese, “We have developed and analyzed an epidemiological intervention model that leverages serological tests to identify and deploy recovered individuals as focal points for sustaining safer interactions via interaction substitution.” Okay, great. But, as Alex Tabarrok has pointed out, this would create an economic incentive for people to develop immunity by intentionally getting the disease. Of course, we could solve this problem by introducing variolation into the mix. * “T cells found in COVID-19 patients ‘bode well’ for long-term immunity.” Also important: “We may have some small residual immunity from our exposure to common cold viruses.”
Social Distancing: Michael Pettis of Peking University posted and commented on a really interesting graph: “Tang Jie, one of the very smart students in my Sunday seminar, presented the following graph in today’s meeting. It shows subway ridership this year in 30 major Chinese cities compared to the same period last year. Jie pointed out at least three interesting things about this graph. First, while subway ridership dropped sharply during Chinese New Year for both years, in 2019 it recovered within a week, whereas this year we have seen only a partial recovery over the 14 weeks of lockdown. As of last week ridership during the work week (the graph shows, not surprisingly, how ridership is much higher on weekdays than on weekends) was just over 60% of 2019’s level. Second, notice how every Friday, in 2019, ridership surges. This is almost certainly because after work, there is a second wave of ridership as people go out on weekend nights. So far this year even as ridership recovers we haven’t seen the Friday surge. This shows pretty clearly that while life is returning to normal from a work perspective, it is taking longer from an entertainment perspective. The third interesting thing about the graph reinforces the second: weekend ridership has recovered by a lot less than weekday ridership—it is just over 50% of normal. Together these suggest that it might take a lot longer for most people to return to their normal lives as consumers than to return to their normal lives as workers.”
Exit Strategies—Restaurants: Colorado Governor Jared “Polis says draft guidance for restaurant re-openings will be released today or tomorrow. Asks cities and counties to examine options for expanded outdoor dining on sidewalks/parking lots to allow 100% or even 150% capacity,” reports Kyle Clark. This seems like a great idea. We know the disease spreads much less-well outdoors. Note: I think small, table-sized umbrellas could block the sun, whereas large, multi-table tents probably would impede dissipation of the virus.
Exit Strategies—Dumb Reopening: As I reviewed May 12, John Cochrane thinks “dumb reopening might just work.” Today he gave a presentation in which he shared some of the same ideas and discussed the longer-term prospects for the economy. I Tweeted a summary. A key line: “People are not rats. They read the newspapers and respond to what’s going to happen.” He also discusses the problem of supespreader events. Here’s how he describes the proper broad goal: “Get the reproduction rate under 1 at minimal cost to GDP.” It’s a problem, then, to impose high costs for little or no gain in bringing down reproduction.
Exit Strategies: I Tweeted, “I increasingly think the ‘flatten the curve’ packaging was a really bad idea, as it gave people the wrong idea that hospital capacity is the key metric and that people were in for a limited-term effort. I think the message from the outset should have been, ‘We need to drive down the effective reproduction rate and keep it down until there’s a vaccine. One of the key immediate needs is to ensure adequate hospital capacity.'” * Doyle McManus worries that Americans simply won’t buy into the test-trace-isolate strategy. But I think he’s pretty dramatically overplaying the opposition. Sure, there are a few loudmouths who refuse to wear masks and who might refuse to get tested. But I think the overwhelming majority of Americans would love the opportunity to get tested and would fully understand why sick people need to stay isolated. * Polling suggests that a large majority of Americans are very worried about the economy reopenning.
Lockdowns: Steve Horwitz writes, “Only when . . . Americans decide that we are comfortable with resuming various kinds of economic activity because we believe it to be safe will that activity happen. . . . The evidence is pretty clear that we began withdrawing well before governments at all levels turned practice into legal decrees.” * Although I often disagree with Jeffrey Tucker regarding the COVID crisis, he does offer a really useful review of the origins of the lockdown model. He quotes a New York Times article to the effect that the modern lockdown strategy originated, not with epidemiologists, but with an intensive-care doctor, and oncologist, and a high school student. He also cites a 2006 paper (lead author Thomas Inglesby) that strongly rejects “large-scale quarantine.” * Andrew Friedson thinks lockdowns do increase social distancing relative to voluntary efforts; see the April paper summary or the (stunningly long) 88-page pdf (lead Friedson), which focuses on California. I’d like to see a (much shorter!) follow-up based on continued data. Offhand I doubt the paper is properly taking into account the way that public fear drives both policy and social distancing. * Meanwhile, a May paper by lead author Raj Chetty argues that “economic activity was not driven directly by the formal shut-downs themselves, but rather a general response to the onset ofthe national COVID-19 epidemic.”
Vaccine: Moderna has had some good early results with its human vaccine trials.
Sweden: The death toll in Sweden stands at 3,679. Daily reported deaths have jumped around pretty erratically from 5 to 147; I don’t see an obvious trend line. The peak remains April 22 with 185 daily deaths reported. Deaths per million sit at 364 for Sweden, compared with 271 for the U.S., 43 for Norway, 54 for Finland, 94 for Denmark, 331 for the Netherlands, 95 for Germany, and 431 for France. * Swedes pretty dramatically altered their behavior even without formal orders. The Economist: “Use of public transport has fallen significantly. A third of people say they avoid going to their workplace (by working from home, for example)—up from 10% in mid-March. Daily restaurant turnover fell by 70% in the month through April 22nd.” The article sensibly notes that it’s too early to compare Sweden’s strategy to that of other countries, given others now face partial reopening. I agree with Lyman Stone that Sweden should have taken other measures (I say test-trace-isolate, Stone says central quarantine) to keep its death counts lower. * Adele Lebano, an Italian living in Sweden, on the other hand, is convinced that “Sweden’s Relaxed Approach to COVID-19 Isn’t Working.” A key point: “Sweden has also decided not to track the disease’s spread and their testing lags far behind other countries.” Checking in with Our World in Data again, I see Sweden has tested a total of 17.55 per thousand people as of May 10. This compares to 66 in Denmark (May 16), 40 in Norway, 26 in Finland, and 32 in the United States. Lebano sees lots of social interaction, but I trust organized data over personal anecdotes. * Lyman Stone claims that “neither Iceland nor Finland have gone into full lockdowns either” (as with Sweden), suggesting “that lockdowns are only weakly associated with better outcomes.” I’m not familiar enough with the policies of those countries to comment. * Eric Feigl-Ding reports that Sweden’s daily deaths per capita now leads the world.
Media: Patrick Muldowney posts two photos of the same beach scene, one making the beach seem barely used, the other making it seem extremely crowded. Remember that journalists often are rewarded for drawing eyeballs, not providing context.
Humor: An official from New York’s Nassau County explains the proper way of handling tennis balls during a pandemic. This is awesome.
Bad Actors: Protesters meanly treated journalist Kevin Vesey. * “State Rep. Mark Baisley, a Republican from Roxborough Park, requested an investigation and criminal charges against Jill Hunsaker Ryan, director of the Colorado Department of Public Health and Environment, for allegedly falsifying death certificates to inflate COVID-19 deaths.” That’s ridiculous.
Lockdowns: Marc Bevand offers really interesting data showing the relationship between stay-at-home orders in U.S. states and daily deaths per capita. Indeed, there seems to be a relationship between the issuance of the orders and a (lagged) peaking or declining of daily deaths. Bevand takes this as “evidence of the effectiveness of stay-at-home orders.” But of course it isn’t necessarily evidence for that, because both stay-at-home orders and people’s willingness to social distance can be explained by people’s level of worry about the disease. In other words, we should expect that people more willing to install and support a government that imposes a stay-at-home order are also more likely to stay at home regardless. Beyond that, there’s a lot of messiness in the data that makes firm conclusions difficult. For example, some states that Bevand counts as evidence in his favor seem to have been flattening the curve before Bevand says they should. Anyway, I’d rather see straight daily death charts, by date of death rather than by report date (which I know Colorado provides), rather than the “7-day centered moving average of daily death” that Bevands uses. * Bevand cites a May 7 paper (lead author Hamada Badr) to support his claims about the efficacy of stay-at-home orders. But the paper actually strongly undermines Bevand’s thesis. From the abstract: “Our analysis reveals that social distancing is strongly correlated with decreased COVID-19 case growth rates for the 25 most affected counties in the United States, with a lag period consistent with the incubation time of SARS-CoV-2. We also demonstrate evidence that social distancing was already under way in many U.S. counties before county and state-level policies were implemented.” Deeper in, the paper (pdf) is even more explicit: “This study . . . reveals that social distancing (and outbreak growth deceleration) in the counties most affected by COVID was driven primarily by local-level regulations and changes in individual-level behavior; the state (and federal) actions implemented were done so either too late (or not at all). This is an important insight, as it demonstrates (given the clear correlation we present between social distancing and case growth), that it is within the power of each U.S. resident, even without government mandates, to help slow the spread of COVID-19. Critically, if individual-level and local actions were not taken, and social distancing behavior was delayed until the state-level directives were first implemented, COVID-19 would have been able to circulate unmitigated for additional weeks in most locations,inevitably resulting in more infections and lives lost.” See the paper for its expressed limitations, including imprecise case counts due to inadequate testing.
Sanitation: Jason Crawford reminds us of the critical role sanitation has played historically in beating back diseases.
Exit Strategies: Carl Bergstrom summarizes a May 4 paper by lead author Alberto Aleta. “They find that with a staggered reopening, isolation of symptomatic cases is insufficient to prevent a large second wave that would overrun hospital capacity. Adding a fairly modest level of contact tracing and family-scale isolation brings the second wave under control.”
Colorado: Hundreds of people protested at the state capitol today, demanding the economy “open up.” I didn’t see a single person (other than police officers) wearing a mask in the photos provided by the Denver Post or in video posted on Twitter. These people seem to have fundamentally misconceived the problem. It’s not like things would just go back to normal but for government restrictions.
Colorado Projections: I’ve just come across this cool COVID-19 Projections page for Colorado. I have no idea how sounds its assumptions are, but apparently it’s been pretty accurate. The main thing that stuck out to me is the estimate that Colorado’s reproduction rate has already moved above 1. The site estimates our total deaths by August 4 to be (around) 3,900 (with a range of 2,000 to 7,000). The site estimates our total infection rate is around 3%, which sounds right to me based on the state’s (nonrepresentative) antibody test reports. The site predicts we’ll reach 7.5% infection by August 4 (with a range of 3% to 15%).
Antibodies: “So far there appears to be a benefit from using . . . convalescent plasma, at least in some situations, said Dr. Kyle Annen, medical director of the transfusion service at Children’s Hospital Colorado.”
Social Change: “Work-from-home productivity pickup has tech CEOs predicting many employees will never come back to the office.”
Flu deaths: The U.S. doesn’t seem to be on track for unusually low flu deaths. That surprises me. I figured that with all the social distancing flu would be down.
Social Engagement: “People flock to NYC-area bars, beaches as ‘quarantine fatigue’ intensifies.” I’m not too worried about the beaches. I’m worried about packed indoor spaces.
Colorado Timeline: The Denver Post has a good early timeline of COVID-19 in Colorado. Here are some highlights:
March 5: First confirmed case.
March 10: Governor Jared Polis declares a state of emergency.
March 11: The NBA suspends games, various Colorado universities move to online classes.
March 12: Denver Public Schools announces a three-week closure.
March 13: First confirmed death.
March 14: Polis suspends downhill skiing.
March 16: Polis orders bars and restaurants closed.
March 19: “Polis suspends all nonessential medical procedures in Colorado.”
March 23: Denver issues a stay-at-home order.
March 25: Polis issues a statewide stay-at-home order, effective March 26.
April 6: CPR adds that on April 6 Polis extended the stay-at-home order through April 26.
Testing Debate: Jacqueline Stenson runs down the case for mass testing. Michael Hochman is skeptical. The basic problem is that lags between tests (Romer calls for testing everyone every two weeks) and for results would mean that many asymptomatic carriers are not discovered in time. And then there is the problem of false negatives (and false positives). Hochman’s concerns about people congregating at testing centers would be alleviated by in-home spit tests. Hochman instead calls for targeted testing along with improved social hygiene (masks, sanitation) and “continued social distancing.” Hochman isn’t even that big of a fan of contact tracing: “Nations like South Korea and Germany that suppressed initial outbreaks with aggressive testing and tracing have experienced resurgences after reopening their economies.” Well, these “resurgences” have been relatively mild. German’s daily death count peaked on April 16 with 315; on May 17 it was 33. South Korea peaked on March 23 with 9 deaths and has recently been running between 0 and 2. That seems pretty effective to me. So what should we do with the tests, according to Hochman? “I believe that the most important role of testing will be for monitoring Covid-19 within communities to guide the tightening and loosening of social distancing restrictions.” My take: We should have more tests, more contact tracing, and more social hygiene, along with good cocooning of the vulnerable. It’s not either-or.
Quarantine: According to Joseph Gerth, Ayn Rand advocated “a philosophy that puts one’s own personal desires and individual wants above all else.” In his story, this view led Rand Paul to put others at risk of coronavirus infection. But Rand advocated rational self-interest in the context of individual rights, not subjectivism. Here is what Rand actually said on the issue of infection diseases (from Ayn Rand Answers, p. 13): “If someone has a contagious disease . . . against which there is no inoculation, then the government has the right to quarantine him. The principle here is to prevent diseased people from passing on their illness to others. Here there is a demonstrable physical damage. In all issues of government protection against physical damage, before the government can properly act, there must be an objective demonstration of an actual physical danger. To quarantine people who are ill is not a violation of their rights; it merely prevents them from doing physical damage to others.” So Rand definitely would support quarantines of people known to have COVID-19, and she definitely would reject the sort of mass lockdown we’ve endured. The problem is in the grey areas, as I discuss below regarding the comments of Onkar Ghate (a philosopher who advocates Rand’s ideas). To a large degree, we are dealing with likelihoods, not certainties. Tests for COVID-19 are imperfect and can yield both false positives and false negatives. What about close contacts of the infected? What about people coming into the country from known hot spots? In my view, quarantines properly may be used to temporarily stop people who are likely infected with the virus from exposing others. It’s unclear to me where Rand would draw those lines. But I agree with Rand’s contemporary advocates that government should be providing a lot more testing to get a much more precise idea of who carries the virus and who does not.
Disease Prevalence: An article by Aleszu Bajak and Jeff Howe reviews the problems with the Santa Clara study (which seemed to show very-high prevalence and a correspondingly low fatality ratio). A main problem is the sample was not random. Despite its problems the study spread over “right-wing” media channels. * Colorado reports PCR tests separately from serology (antibody) tests, which is good. The past few days the serology tests have been running around 6–8% positive. I take that to be the upper boundary of the true infection rate, given the tests are not given randomly. As far as I know all of these tests are used by people who think they likely have had COVID-19. This suggests that Colorado is far, far away from herd immunity. * Natalie Dean is skeptical that 25–30% of people in Stockholm have already been infected. Stefan Schubert cites media reports claiming that the infection fatality rate there is 0.6%, which seems to imply that around 10% of the population has had the disease.
Testing Regulations: “F.D.A. halts coronavirus testing program backed by Bill Gates. The program allows people in the Seattle area to easily take a coronavirus test at home.” This stoppage is ridiculous. “The issue in the Seattle case appears to be that the test results are being used not only by researchers for surveillance of the virus in the community but that the results are also being returned to patients to inform them. The two kinds of testing—surveillance and diagnostic—fall under different F.D.A. standards.”
Lockdowns: A new (May 14) paper from Health Affairs (lead author Charles Courtemanche) argues that shelter-in-place orders (SIPs) in the U.S. dramatically curtailed the rise of positive COVID-19 cases. The paper includes the following chart illustrating its findings.
The is a logarithmic scale, so the observed cases peak out at around a million cases on April 27 (as of May 16, the U.S. saw 1.44 million cases), whereas the counterfactual estimate without SIPs is 10 million. But this result holds “holding the amount of voluntary social distancing constant,” which seems to me to be a fatal error. No sane person thinks that would have held constant. The authors admit as much: “We urge caution about taking the specific numbers of cases averted too literally. . . . [H]ad policymakers not taken action and COVID-19 had continued to spread throughout April in the manner depicted by our simulations, voluntary social distancing by individuals and businesses would have likely increased as panic over the rising death toll and hospital overcrowding across the country mounted.” * Robert VerBruggen worries about a more-technical point: “They’re measuring changes in the log of cases, adding one to avoid dropping zeroes, and weighting by population rather than cases. So a huge county that goes from 1 to 2 cases is counted as doubling in a single day and given a huge sway over the result, no?” * I also doubt the study properly accounts for such possibilities as a declining average effective reproduction rate due to more-vulnerable and more-susceptible people having already gotten the disease (see references below). And obviously governments could have done a lot other than what the study considers to drive down spread (cocoon the vulnerable, build a test-trace isolate capability).
Lockdowns: Phil Magness comments, “Schrodinger’s Lockdown is simultaneously responsible for preventing a gazillion deaths by stopping people from leaving their homes and spreading the virus, but it isn’t the cause of any ill economic effects since people were already staying at home anyway.”
New York vs. San Francisco: ProPublica has an interesting comparison: “As of May 15, there were nearly 350,000 COVID-19 cases in New York and more than 27,500 deaths, nearly a third of the nation’s total. The corresponding numbers in California: just under 75,000 cases and slightly more than 3,000 deaths.” The problem, according to the article, is that San Fransisco and California shut down early while New York waited. Of course, the article notes, New York City is denser and has a usually-packed subway system. I would also look to more-granular policy differences, such as New York’s treatment of nursing homes. * “New York Sent Recovering Coronavirus Patients to Nursing Homes: ‘It Was a Fatal Error’.”
Superspreaders: Adam Kucharski points out that a disproportionate number of SARS-CoV-2 transmissions come from superspreading individuals and events. He points to three papers. April 9 lead Akira Endo: “Our finding of a highly-overdispersed offspring distribution highlights a potential benefit to focusing intervention efforts on superspreading. As most infected individuals do not contribute to the expansion of an epidemic, the effective reproduction number could be drastically reduced by preventing relatively rare superspreading events.” February 15 lead Kyra Grantz. May 1 lead Quentin Leclerc: “We found many examples of SARS-CoV-2 clusters linked to a wide range of mostly indoor settings. Few reports came from schools, many from households, and an increasing number were reported in hospitals and elderly care settings across Europe.” * Faye Flam summarizes Muge Cevik, “Most people transmit the disease to nobody, or one person, and a minority infect many others in so-called super-spreading events. . . . Nine percent of infected people are responsible for 80% of the transmissions.” Notably, Cevik thinks, transmissibility is related to severity of symptoms. * An April 4 paper (lead Hua Qian) found that, out of 1,245 cases in China (not necessarily representative), “only a single outbreak [occurred] in an outdoor environment, which involved two cases.” * Erin Bromage writes (May 6), “We know most people get infected in their own home. A household member contracts the virus in the community and brings it into the house where sustained contact between household members leads to infection.” He summarizes that superspreading events occur in crowds: meat-packing plants, weddings, funerals, birthday parties, business networking events. Other good places for spread include restaurants, workplaces, choir, and indoor sports. The main problem is going “indoors, with people closely-spaced, with lots of talking, singing, or yelling.” Sum: “The main sources for infection are home, workplace, public transport, social gatherings, and restaurants. This accounts for 90% of all transmission events. In contrast, outbreaks spread from shopping appear to be responsible for a small percentage of traced infections.” (Here Bromage quotes the Qian paper.)
Africa: Yes, Africans are younger, more dispersed, and more outdoors. But Some people think sub-Saharan African governments also responded well to the crisis. John Nkengasong, the director of the Africa Centres for Disease Control and Prevention, told the New Yorker, “The continent of Africa reacted aggressively. Countries were shutting down and declaring states of emergency when no or single cases were reported. We have evidence to show that that helped a lot.” Rwanda, for example, implemented the familiar test-trace-isolate strategy along with restrictions on travel and sociality. A similar story holds for Uganda, Ethiopia, and South Africa. A big problem remains the availability of tests. (It occurs to me that if the U.S. had its act together we could robustly test ourselves and also assist poorer nations with this.)
Exit Strategy: Alex Tabarrok and Puja Ahluwalia Ohlhaver argue the U.S. “could stop the pandemic by July 4.” They offer the now-familiar mix of test-trace-isolate. “Isolated patients would receive a federal stipend.” This is interesting: “The country should be divided into red, yellow and green zones. The goal is to be a green zone, where fewer than one resident per 36,000 is infected. Here, large gatherings are allowed, and masks aren’t required for those who don’t interact with the elderly or other vulnerable populations.” Now, America is divided into yellow and red zones, with red as “a disease prevalence greater than 1 percent.” The authors think the U.S. needs 5 million tests per day, a lot more than we have, but a lot fewer than what Romer proposes. This all would require $75 billion in federal spending, they anticipate. * Both authors contributed to Harvard’s Safra Center’s May 12 Pandemic Resilience report.
Social Distancing in the U.S.: Gallop asked people whether they are isolating themselves or having contact with people outside their household. But, as Jacob Sullum points out, those aren’t very helpful questions. People can be around others with masks, appropriate distancing, and, best yet, outside. Sullum summarizes, “Fifty-eight percent of respondents [surveyed May 4 to May 10]said they were completely or mostly isolating themselves, down from a peak of 75 percent in a Gallup poll conducted from March 30 to April 5.” Notably, various county-level stay-at-home orders Colorado ended on May 8. Sullum points to a more-helpful survey by Piplsay. I’ll summarize some of the major findings: 53% of people said they’re “very comfortable” returning to work “but with adequate precautions, 29% said they’re “not very comfortable,” 18% said they’re “not at all comfortable” (so 47% combined uncomfortable). Only 24% said they’re “very comfortable” resuming public transportation “but with adequate precautions.” Only 24% said they’d immediately visit “restaurants, malls, gyms, salons, etc.”; 76% said they’d wait weeks or months. Only 29% said “I have already started socializing” with friends and family (in person); 73% said they’d wait weeks or months longer. * “A Washington Post-Ipsos poll of more than 8,000 adults in late April and early May found that nearly 6 in 10 Americans [58%] who are working outside their homes were concerned that they could be exposed to the virus at work and infect other members of their household.” A third of Americans have continued to leave the house for work, and “Nearly 8 in 10 Americans leaving home for work said their employers were doing enough to keep them safe.”
Immunity: Not only are San Diego patients who recovered from COVID-19 showing immunity, but people who have never had the disease are showing immunity, presumably from exposure to other coronaviruses. Here’s the study (lead author Alba Grifoni).
Colorado Reporting: Governor Polis announced today that the state would start to distinguish deaths related to COVID-19 and deaths “due to” the coronavirus. And the state has done so. Today’s stats list 1,150 related deaths and 878 deaths “due to” the virus (24% fewer). That got me wondering whether relevant deaths are still being undercounted. Westword suggests that Colorado had 905 “excess deaths between February 1 and April 11.” Looking at the CDC’s weekly death counts by state, I see weekly counts mostly in the 800s from December 21, 2019, with some spikes over 1,000 in April and then dropping again in late April. Clearly we did have a spike, but I haven’t run the numbers to check “excess deaths.” (There’s an odd report for May 9 of 263 deaths, which I suspect is just an error or an incomplete result.)
Smoking: Eleanor Murray has a plausible explanation for why smokers seem to be underrepresented for COVID-19: They tend to die younger and so do not make it into high-risk elderly-care homes. In a May 7 Tweet thread, Murray offers an extended critique of the May 7 paper at hand (lead author Elizabeth Williamson). One of the things Murray worries about are confounded variables: “When we look at the current smokers, the first numeric column tells us they were 25% more likely to die than never smokers of the same age and sex in the sample.”
False Choices: My new article for Complete Colorado makes two basic points. First, business owners and individuals have a responsibility to act to as to mitigate the risks of the disease. Second, government has a responsibility to build a serious test-trace-isolate capacity to free “people to produce and otherwise engage socially.” * Travis Heath makes a similar point: “I’ve got to hand it to us, we sure know how to stay on brand here in America. Either we have to stay home altogether for years or just reopen with zero precautions. Create a dichotomy and make the people feel as though those are the two options.”
Lockdowns: The New York Times has out a May 12 story titled, “As Coronavirus Restrictions Lift, Millions in U.S. Are Leaving Home Again.” The headline leaves open the question of whether people are “leaving home again” because of the restrictions lifting. The article is based on cell data, which of course are an imperfect indicator. Indeed, the Cuebiq data include only “a representative sample of about 15 million smartphone users nationwide,” the paper notes. But there’s no way to tell how “representative” the sample actually is. The basic chart of “people who stayed home” shows a flat line with weekends peaking over 25%. This roughly doubled from early to mid-March, and it has been steadily declining since mid-April. The “average during the peak period for sheltering in place” (March 20 to April 30) is 43.8%; it dropped to 36.1%. The pre-pandemic average was 20.7. The paper notes, “In places where statewide orders continued to limit people’s movements and to close businesses, like New York and New Jersey, more people continued to stay home. In states that had started to slowly reopen, including South Carolina and Florida, a greater share of people ventured out.” But this does not show a causal link. At least to a large degree, both shutdown orders and people’s willingness to travel are caused by perceived severity of the illness in a given region. Notably, every state “with stay-at-home orders in effect” saw a drop from the peak, ranging from a 5% drop in Arizona to a 10.9% drop in Michigan. Notably, Colorado saw a drop of 9.2%, from 46 to 37 percent (up from a pre-pandemic 23%). “Colorado still had the highest average share of people staying home among reopened states,” the article notes.
Lockdowns: Emily Oster makes the excellent points that dumbing down health advice and offering stark all-or-nothing recommendations (such as “stay at home”) generally is foolish and counter-productive.
Exit Strategies: Matthew Yglesias has a good overview of exit strategies. His seven main strategies involve masks, vaccines (of course), more testing, more contact tracing, out-of-home quarantines to prevent household spread, more outdoor activities, and spending federal (borrowed) dollars on all of this. * This is a remarkable finding (Yglesias still): “A study by a team of five researchers out of Hong Kong and several European universities calculates that if 80 percent of a population can be persuaded to don masks, that would cut transmission levels to one-twelfth of what you’d have in a mask-less society.” The relevant paper is from April 22, lead author De Kai. There are some important qualifiers in the paper. There is “minimal impact when only 50% or less of the population is wearing masks” and “when universal masking is adopted late” (after Day 50). * Another article that Yglesias cites is Paul Romer’s “If Virus Tests Were Sodas.” Although Paul Romer doesn’t put the point this way, here’s what his article screams to me: We don’t have mass testing because we’ve destroyed the relevant marketplace through third-party payers and regulations. Romer asks us to imagine if we bought sodas the same way we’re supposed to buy COVID-19 tests. Soda would cost $20 per can and hardly anyone would get one. The main practical problem is that there’s no money in testing. Here is how Romer concludes: “If we want to use this nation’s massive capacity–much of which, by the way, is now sitting idle–to produce tens of millions of virus tests per day, there is a way to do it: Decide what a test should do. As long as labs provide tests that do what a test is supposed to do, let them worry about the details. Do not appeal to charity; be prepared to pay these labs twice as much as we spend on soda.” Here’s a point I added on Twitter: “This is so insane. I would very happily pay a hundred bucks per test to get tested twice per month, yet I am legally forbidden to buy even a single test for any amount of money” (because I don’t have symptoms and am not in one of the special classes).
Superspreaders: Tomas Pueyo has a nice round-up of cases and studies about superspreading events. He also points out that people are likely to pick up the disease from an infected relative with whom they have prolonged contact. His conclusion: “Countries that want to dance successfully might be able to do so with just testing, contact tracing, isolations, quarantines, masks, hygiene, physical distancing, and public education. On top of that, they might need to limit social gatherings until coronavirus prevalence is low and they figure out ways to limit contagions in these events. Throughout the dance, they will have to limit infections coming from abroad through quarantines, filtering measures at the borders, or outright bans.”
Timeline: Although it’s hard to correctly interpret a couple of test results, some people think COVID-19 was spreading in the U.S. in December (the story pertains to Washington state). Of course one possibility is simply that some people experienced a non-related illness first and then later contracted the coronavirus. This is what Trevor Bedford thinks. He mentions a false positive was also possible.
Georgia: The Federalist has gone seriously downhill over the last few months, but David Marcus makes the fair point that Georgia’s loosening of restrictions has not induced catastrophe. Looking at Georgia’s COVID-19 page, total death count is 1,557. It seems like daily case and death counts are starting to decline, but it’s too tell the trend. Both the Infections Tracker and RT.live show Georgia’s effective reproduction rate as under 1, so that’s good.
Colorado: Westminster city voted to require masks in public, but it’s not enforceable. Councilor Anita Seitz told Colorado Community Media, “It’s giving cover to our business community that does not want the backlash of asking someone to wear a mask but does want to protect the other customers and their employees. I think that’s a valid reason to want to have this, even without the teeth of a penalty.” * Chris Vanderveen reports, “Colorado Dept. of Corrections CONFIRMS that man arrested in weekend homicide of woman at 14th and N. Verbena in Denver was released by prison system on April 15 Release was ‘a special needs parole’ due to COVID-19 concerns in state’s prison system.”
England: It appears likely that the effective reproduction rate is under 1 throughout most of the UK.
Testing: Howard Forman sounds an optimistic note: “US testing now close to 320K+ rate and doubling every 4 weeks. Puts us on track for 2.5M daily testing in early August. This makes me much more optimistic that schools and big parts of the economy will reopen by end of summer with lower risk of big second wave. keep it up!”
Trendlines: Axios has a nice summary (via email): “Active case counts are flat or falling in most of East Asia and the Pacific, as well as in Europe (with notable exceptions including Russia and the U.K), according to a report from Albright Stonebridge Group. But they are rising in the vast majority of countries across Latin America, the Middle East, South Asia and Africa. . . . However, testing rates in countries like Nigeria remain so low that it’s impossible to get a clear picture of the outbreak.”
Treatments: “Early Safety Indicators of COVID-19 Convalescent Plasma in 5,000 Patients.” Yeah, but does it work?
Minnesota: An article by Joe Carlson and Glenn Howatt offers a really good summary of where Minnesota sits. Upshot: Best estimates indicate Minnesota’s effective reproduction rate is barely below 1, so loosening up may drive it higher than 1.
Reproduction and Herd Immunity: An April 27 paper (lead author Gabriela Gomes) makes a point that is obvious on reflection: The first wave of an infectious disease hits those most prone to get it, either because of physical traits or social interactions. This implies 1) a second wave is probably less severe and 2) the fraction of the population needed to reach herd immunity is probably lower. This is the part where I grow skeptical: The paper claims that, with the right assumptions, herd immunity might be reached with only 10% infection rate. This seems to be based on a lot of guesswork. However, the paper cites various regions that seem already to have reached 20-plus percent immunization rates, so that may be a better indicator. Here is a useful line (from the pdf): “Countries where suppression of the initial outbreak was more successful, such as Austria, have acquired less immunity and therefore the potential for future transmission in the respective populations remains naturally larger. However, also in these situations, expectations for the potential of subsequent waves is much reduced by variation in susceptibility to infection.” One issue is that how susceptible people are to infection depends radically on the changing behaviors of individuals. People can make themselves more or less susceptible. Obviously, if people changed their behavior to become more-social, the threshold for herd immunity would go higher.
Colorado COVID-19 Deaths: “Over 57 percent of Colorado COVID-19 deaths linked to long-term care facilities.”
Discontents: Lauren Boebert is a Congressional candidate and the owner of Shooters Grill in Rifle, Colorado. “She opened up last weekend for dine-in service at 30% capacity,” reports KJCT8. She told the station, “I’ve been patient, followed all of the proper channels, and provided services in a safe and responsible manner using the same guidelines as neighboring Mesa County restaurants. Yesterday, Governor Polis bragged to President Trump about Colorado opening, but the reality is that small business owners like me who don’t have Washington DC lobbyists are getting crushed and being treated like criminals while big box stores are open for business.” Boebert posted a photo of well-spaced tables outside.
Colorado: “Colorado Investigates Whether National Guard Testing Spread Coronavirus In Nursing Home.”
Regulations: Colorado ranchers are struggling. Meanwhile: “The beef market is complex and burdened with regulations that make it all but impossible for individual ranchers to sell their own meat at retail. The biggest impediment is federal law, which makes it illegal for a livestock grower to cut and pack his own meat and sell it to retail stores” (Complete Colorado). Here’s an interesting detail: “Earlier this month, Colorado Attorney General Phil Weiser signed on to a letter, along with attorneys general from other beef producing states, urging the Department of Justice to look into possible price manipulation in the industry.” So, by my read, the federal government’s regulations created extreme market concentration in the feedlot and meat packing industry, and now the government is worried about “price fixing.”
Bad Actors: “7-Eleven worker beaten, doused with coffee after telling man to wear mask, IN cops say.” Disgusting.
Wisconsin: “Wisconsin Supreme Court strikes down state’s stay-at-home order.” Or not. Timothy Sandefur summarizes, “What the decision says is that while the Governor can issue an emergency order, an unelected administrative official who purports to issue a regulatory rule (with criminal penalties!) must follow the rule-making procedures set by the people’s elected representatives.” It’s unclear to me whether the governor could simply issue an “order” with the same content of the previous rule. Update: Sandefur says he agrees with the dissenting opinion.
Sweden’s Economy: Will Sweden’s relatively light touch with respect to government restrictions on social engagement yield large economic benefits? Richard Milne thinks not. Swedes voluntarily increase their social distancing, hurting restaurants and such. And: “Truckmaker Volvo Group and carmaker Volvo Cars were both forced to stop production for several weeks, not because of conditions in Sweden but due to lack of parts and difficulties in their supply chains elsewhere in Europe.” Some Swedish economists expect a drop in GDP by 6.5% this year compared to “9-10 per cent falls in Finland and Denmark.” Some Swedes think they’d have done worse overall (economically) with a lockdown, especially considering that other countries may struggle to reopen. Here is a key bit about the relative effects of lockdowns: “Data on the use of public transport, credit cards and restaurants show big falls in Sweden as authorities urge people to work from home where possible and maintain social distancing. But the declines are less precipitous than other European countries under full lockdown.”
COVID-19 Death Count: Although we can dispute whether this or that reported COVID-19 death actually was caused by the disease, it seems clear that overall the numbers are underreported. Nicholas Kristof thinks the “true COVID toll already exceeds 100,000” in the U.S. Update (May 15): Polis says state numbers will clarify whether people have died of COVID-19 or with it (as an incidental condition).
Service or Work: David Brooks thinks we need an expanded “national service” program to pay people for “contact tracing, sanitizing public places, bringing food to the hungry, supporting the elderly, taking temperatures at public gathering spots, supporting local government agencies, tutoring elementary school students so they can make up for lost time.” I think that’s the totally wrong way to think about it. I think government needs to hire contact tracers and the like as a means to fulfilling the government’s legitimate function of protecting people from others’ infections.
Science and Policy: Philosophers Ben Bayer and Gregory Salmieri discuss whether government should just “follow the science.” Bayer references articles by Rich Lowry and Fareed Zakaria on the topic. Zakaria makes (at least) a couple of good points. Science, especially regarding a new phenomenon, is by its nature often uncertain and searching. And the science about COVID-19 per se tells us nothing about the downsides of various policies. Bayer makes the deeper point that ethics properly informs politics. Epidemiology is silent on issues such as the importance of quality of life. Salmieri points out, though, that, when providing end-of-life care, doctors typically do bring in concerns about quality of life. Bayer also talks about an article by Jeremy Samuel Faust and Carlos del Rio about excess mortality. Obviously that figure gives us a better sense of the overall costs (in terms of lives) associated with the pandemic than do straight coronavirus-realted death counts. Yet, as Bayer sensibly notes, there’s nothing magical about the pre-pandemic death rate; perhaps individuals, in the context of the crisis, would consider themselves better-off by trading some margin of safety for other values. Salmieri makes the practical point that death rates hide very significant time lags.
Colorado: Jennifer Hulan’s Waters Edge Winery & Bistro briefly reopened against health orders but then shut back down. This is in Centennial, subject to the Tri-County Health Department. * Many Colorado restaurant owners fear their establishments will go under. * EndCoronavirus.org lists Colorado among the states that “need to take action” to bring down case counts. * Colorado’s Sterling Correctional Facility (prison) “now has 440 positive cases among inmate population.”
California: Governor Gavin Newsom said Tuesday, “We have the ability to do martial law . . . if we feel the necessity.” What a foolish threat.
Biology: One of my friends recommends MedCram’s videos about the medical and biological aspects of COVID-19. * 23andMe is leading a study to try to figure out what the genetic component of susceptibility to COVID-19 might be. * For some people recovery from COVID-19 is a long road. * Children in Italy also are coming down with “Kawasaki-like disease.” New York has already been in the news for this. * Wow. “A new study estimates that a single minute of loud speaking generates at least 1,000 covid-containing droplets, and these droplets stay airborne for longer than eight minutes, and sometimes as long as 14 minutes.”
Go Outside: An April 4 paper looked at cases in China and, among cases considered, found an extremely low number of transmissions outside. Conclusion: “Sharing indoor space is a major SARS-CoV-2 infection risk.” * “Sustained indoor contact with a lot of conversation is higher risk” (Natalie Dean).
Singapore: First let’s review some of the basic stats regarding Singapore, a country with 5.6 million people (roughly the population of Colorado). Singapore has only 21 related deaths (3.59 per million), compared with 1,009 for Colorado. So clearly reports about Singapore’s “failures” are overblown. Still, Singapore had a jump in active cases. “About 90 per cent of Singapore’s cases are linked to crowded foreign workers’ dormitories that were a blind spot in the government’s crisis management,” Eileen Ng writes. That’s bad; still, seems obvious that younger workers are less likely to die from the disease.
Collateral Damage: The Wall Street Journal reminds us, “Many people are missing regular screenings and checkups with their doctors. Some may be experiencing early symptoms of illness, yet aren’t seeking treatment.” Tragically, some portion of those people will consequently suffer long-term health problems or even death. * Some people experience a “profound burden of extreme physical and social distancing” (Atlantic). * “At least 35 people have died in Mexico after drinking methanol, the latest in a series of mass bad-alcohol poisonings since the country banned beer sales and many towns banned the sale of liquor” (AP).
England and Testing: Matt Ridley writes, “We don’t really know what works. It is possible that washing your hands, not shaking hands with others, not gathering in large crowds, and wearing a face mask in public, but no more than this, might have been enough, as Sweden seems to suggest.” Here is a key bit: “There is one vital fact that emerges from the fog. Countries that did a lot of testing from the start have fared much better than countries that did little testing. This is true not just of many Asian countries, such as South Korea (though Japan is an exception), but within Europe too. Up to the middle of last month, Iceland, Lithuania, Estonia and Germany had done many more tests per million people and recorded many fewer deaths per million people than Belgium, Britain, Italy and Sweden. As Max Roser of the website Our World In Data puts it: ‘The countries with the highest death rates got there by having the lowest testing rates.'” And: “Britain’s failure to ramp up testing in mid-March—and to limit testing to those already in hospital with symptoms—is its biggest mistake, not its failure to lock down the economy sooner.” A widespread problem, Ridley notes, is that the disease spread rampantly in nursing homes. Ridley reasonably thinks that, by protecting hospitals and elder-care facilities, the disease could be considerably tamped down. This is helpful: “If the elderly, obese and frail are not just at greater risk of dying, but also more susceptible and more infectious, then by definition everybody else is less so.” Depending on the degree to which this is so, herd immunity could be reached “with as little as 10 per cent of the population immunised.” That sounds overly optimistic to me, but clearly there’s something to this dynamic.
Colorado Testing: Colorado is nowhere close to mass testing. To date, 109,304 people have been tested, total, a tiny fraction of the population. A state web page explains the many restrictions for testing (accessed today). The state urges testing of “all symptomatic patients.” “In addition, testing of asymptomatic individuals may also be indicated in outbreak settings.” People in hospitals (patients and staff) can get tested, as can people in “long-term care facilities” and first responders. Tests require a doctor order. The upshot is that almost no one in the state can get tested at this point.
Testing: “In Virginia, officials are blending the results of viral tests and antibody tests into one statistic so they can report more favorable numbers to the public” (Robinson Meyer). Colorado is reporting PCR tests separately from serology tests.
Herd Immunity: Michael Ryan gave an impassioned talk against “natural” herd immunity that was widely shared. * Meanwhile, the social scientists Nils Karlson, Charlotta Stern, and Daniel B. Klein argue, “Herd Immunity Is the Only Realistic Option.” Their model, of course, is Sweden. “Efforts to contain the virus are doomed to fail in many countries, and a large percentage of people will be infected in the end. When much of the world experiences a deadly second wave, Sweden will have the worst of the pandemic behind it.” I think that is probably, tragically, right for some poorer nations. But whether there is a “deadly second wave” in richer countries depends on whether people voluntarily keep up social distancing, as John Cochrane thinks they will (see below). Yet I think the authors are basically correct about regions that open up without an adequate test-trace-isolate capacity: The disease probably will continue to spread with an effective reproductive rate of around 1. That may or may not eventually lead to herd immunity, depending. However, the authors basically ignore the possibility of countries reopening with an effective test-race-isolate capacity. Obviously that is possible, as various countries already have done it. * The Karlson-Stern-Klein article prompted an interesting discussion on Twitter when Robin Hanson quoted it. Erik Brynjolfsson replied, “Why do you keep repeating the narrative that lockdowns are intended to stay until there is a vaccine, even as we see them being loosened in countries that have brought the virus under control, exactly as it was described from the beginning?” I replied, “Okay, but show me the actual testing, tracing, and isolation/quarantine capacities that are actually supposed to start the dance phase in the U.S. South Korea is dancing fine; we’re not remotely ready to dance.” Brynjolfsson agreed that’s a legitimate criticism but it still doesn’t mean lockdown or herd immunity are the only alternatives.
Denmark: The country’s plan to reopen involves the standard testing and contact tracing, along with hotel quarantining.
Hong Kong: Zeynep Tufekci makes the case that Hong Kong’s political protests resulted in an organizational infrastructure that also was effective at beating back the coronavirus. “In response to the crisis, Hong Kongers spontaneously adopted near-universal masking on their own, defying the government’s ban on masks.”
Los Angeles: Los Angeles County might keep stay-at-home orders in place through the Summer, although they also might be eased, “depending on conditions.”
Collateral Damage: Dan Mitchell explores some of the health and safety impacts of a shut-down economy. * The Los Angeles Times has out a story, “The economic devastation wrought by the pandemic could ultimately kill more people than the virus itself.” The piece focuses on the world’s “ultra-poor.” “Mohammad S Al-Zawahreh, a Jordanian civil society activist,” says “It’s not going to work to tell these people to develop yourself—learn Skype or Zoom—while their children are starving.”
South Korea: National Geographic has out a new article about South Korea’s strategy. In addition to using mass testing with walk-through booths, South Korea relies on “credit card history and location data from cell phone carriers to retrace the movements of infected people.” People in contact with infected people are quarantined.
Exit Strategy: Vital Strategies has out a “playbook” for reopening. I recommends (wait for it . . .) test-trace-isolate.
Iceland: “Iceland, which has successfully contained the new coronavirus and conducted more tests per capita than any other country, said Tuesday it plans to offer arriving travellers a COVID-19 test to avoid a 14-day quarantine.” Bojan Pancevski says “Austria is doing the same.”
Exit Strategy: Lionel Page reminds me that I needed to read John Cochrane’s May 4 article. Page summarizes: “Epidemiological models did not predict the quick slowing down of the epidemic” because “people adapt their behaviour in many smart ways which decrease infectivity.” Cochrane believes, “Dumb reopening might just work.” He says that the effective reproduction rate “is immensely influenced by human behavior.” Moreover, “The average reproduction rate heavily influenced by super-spreading activities,” and these are precisely what people tend to voluntarily give up. A great line: “As people slowly start to adopt common sense and ignore silly shutdowns, and as people start to adopt common sense and avoid even permitted dangerous activities, the economy can recover a good deal.” The main problem with the epidemiological models, Cochrane says, is that they assume that people don’t alter their behavior. The political subtext to that assumption is, “unless they are forced to.” I think this perfectly explains both why we suffered lockdowns and why the lockdowns didn’t do much good. Cochrane observes: “Growth was never near constant exponential even before shutdowns were announced. 1) We reach a plateau, and then either stay there or see slow decline. 2) The pattern is remarkably similar across countries with very different policies.” Cochrane references work of Michael Levitt and Isaac Ben-Israel along these lines.
Sweden: Johan Norberg offers the Swedish evidence that backs up Cochrane’s thesis (see above). Norberg’s basic point is that the epidemiological modeling pretty radically overshot the actual impacts of the disease. He closes, “What happens if you don’t involve the police, if you don’t issue edicts about how many of your relatives or neighbours you can visit, and just ask people to be careful? Might that work? The Swedish experiment casts huge doubts on the models, and makes the case for trusting the public.” * However, it’s worth remembering that Sweden had a relatively high death toll that “really came as a surprise” to Swedish authorities.
Social Distancing: Nate Silver says, “A lot of evidence suggests that formal re-opening policies are only loosely correlated with people’s behavior. Tennessee (+8%) and Kentucky (+8%) score exactly the same on Apple’s mobility tracker even though Tennessee is ‘open’ and Kentucky is ‘closed.'” That squares with Lyman Stone’s work.
England: Boris Johnson offers “a roadmap for reopening society.” He says the country must meet five tests to reopen: Maintain sufficient hospital capacity, see a “sustained and consistent fall in daily deaths,” achieve a lower rate of infection, get enough tests and protective gear, and prevent a second wave. He said the goal is to keep effective rate of spread lower than 1. The country is instituting five alert levels linked to rate of spread and number of cases. He wants to ramp up testing more. The main change at this point is to get more people back to work as safely as feasible. The government is also increasing fines for people who break the social-distancing rules. Down the road, the government hopes to get shops and schools back open. He talks about opening restaurants and the like by August at the earliest.
Music: Dave Grohl penned a remarkable tribute to the live rock concert.
Colorado: Colorado Public Radio went through an extraordinary amount of documentation regarding the state’s response to COVID-19 (lead author Ben Markus). “When COVID-19 arrived, chaos reigned and plans developed over years of tabletop exercises were almost immediately “overwhelmed,” according to the head of CDPHE [Colorado Department of Public Health and Environment].” Here is a key line: “Contact tracing of positive patients, at least in some counties, was abandoned early as hours were lost to poor communication and the virus got out of control. That essentially ended efforts at containment before they began, despite the emphasis placed on tracing by state health officials. Instead, slowing the virus through extreme social distancing orders became the focus.” On March 2, the report notes, Ning Mosberger-Tang, a Boulder venture capitalist, sent a warning to CDPHE saying, “I think Colorado needs to take Corona Virus more seriously. We need to inform people, test more aggressively, reduce large gatherings, take preventative measures in health facilities, and pay special attention to places where older people or people with existing conditions congregate, etc.” San Juan Basin Public Health director Liane Jollon said, “We can’t reopen our economies. We can’t go back to school. We can’t go back to normal lives without broad testing, broad surveillance, and then really intensive contact tracing, monitoring, and quarantine isolation. And that work is carried out typically at the local level. We have to stand up a lot of capacity really quickly. I am hopeful that we will be able to develop the communication and coordination. We need to do this well.” This is remarkably good journalism.
Pirates: “The Fort Morgan Times [Colorado]says that a rural nursing home that eventually lost 12 residents to COVID-19 had a PPE shipment diverted by FEMA” (Kyle Clark).
Masks: De Kai thinks public masks could help an extraordinary amount.
Discontent: “Elon Musk Says Tesla Is Restarting California Production, Defying Local Order.”
Collateral Damage: U.S. crises centers are handling more calls.
Second Wave: Russ Roberts’s point seems sound to me: “Maybe I am missing something but it seems pretty obvious that a second wave will not be anything like the first. Nursing home will be immensely more vigilant and tragically, but realistically, a lot of the most vulnerable will have had the virus.”
Daily Updates: Let’s start out with a few basic stats. Global daily deaths remains on a downward trend, with 3,393 for May 12. The trendline heads downward in the U.S. too, but with a daily uptick to 1,156. Sweden’s numbers bounce around a lot, but the overall trend appears to me to head downward, with a daily uptick to 31. Colorado sits at 987 total deaths, with only one or two additional deaths each day from May 7 to May 10. (However, there may be time lags involved here.)
Vaccines: Alex Tabarrok makes the case for allowing volunteers to sign up to test a coronavirus vaccine. This is obvious to anyone whose moral views haven’t been warped by ludicrous theories.
U.S. Testing Failure: If you’re looking for an article blaming the Trump administration for the testing failure—and it surely deserves a portion of the blame—Rolling Stone has the article. “The Coronavirus Task Force had resolved to present the president with a plan for mitigation efforts, like school and business closures, on February 24th, but reportedly reversed course after Trump exploded about the economic fallout.” “The government leaders who failed to safeguard the nation are CDC Director Redfield; FDA Commissioner Stephen Hahn; Health and Human Services Secretary Alex Azar; and of course, President Trump.” Read the entire article for the details. I was especially struck by CDC director Robert Redfield’s ties to an anti-gay nonprofit and his general lack of competence. Notably, Scott Gottlieb warned on January 28 that the U.S. government needed to work “with private industry to develop easy-to-use, rapid diagnostic tests” (as South Korea did).
Health Impacts: Historically, the relationship between recessions and people’s health is more complicated than people probably assume (Lynne Peeples, Scientific American). Negatives: The unemployed suffer more stress, suicides, and substance abuse, and they have less money for health care. Positives (for short-term health): More-experienced people left at work have fewer work accidents, people drive less (and so crash less), air quality improves, some people enjoy less stress and more leisure, and some people spend less money on cigarettes and alcohol. * Australia, which has 97 COVID-related deaths as of May 11, may pay for some of that success with higher suicide rates.
Bailouts: “Five western states have signed a joint letter to the leaders of both parties in Congress requesting a combined $1 trillion in coronavirus relief funding from the federal government.” Oregon, Nevada, California, Washington,Colorado.
Bad Actors: A Massachusetts ice cream shop tried to open safely but people harassed the employees. So the shop closed. Update: “Teenager who quit ice cream shop over rude customers gets more than $25K in donations.” * Inmates at the Los Angeles County jail tried to infect themselves with coronavirus, thinking they’d be freed if they caught the disease.
Testing: Keith Humphreys thinks many Americans would refuse to get tested even if they could. I responded, “As a red-blooded American, I want to get tested every two weeks so I can stop worrying about it. I’m pissed that I can’t get tested. I think most people are in that boat.”
SARS 2003 and 2020: David Quammen tells the story of the previous SARS disease. By his account, SARS-CoV-2 didn’t first spread to humans via a meat market; rather, it first spread to humans from a bat, and then an infected person probably spread it via a market. An interesting tidbit: Singapore has negative-pressure rooms for treating patients. Quammen’s account of the U.S. federal government’s (lack of) response is damning. While South Korea built up testing capacity, the U.S. dithered. He quotes Beth Cameron, “You’re not going to stop outbreaks from happening. But you can stop outbreaks from becoming epidemics or pandemics.”
Colorado: The new Test and Trace web site, put up by techies and journalists, offers state-level comparisons. But I’m not sure how accurate it is. It shows Colorado as having only 45 contact tracers out of a needed 1,878 needed. But this seems not to count regional testers. CPR reports a target of 1,740 tracers, “about six times a rough estimate of the current contact tracing now working in state and local health departments.” The broader point remains: Colorado has neither the testing capacity nor the contact tracers to make the test-trace-isolate strategy work.
Masks: Aaron Davis summarizes, “As the pandemic arrived, the U.S. government turned down an early offer to manufacture millions of medical masks in America, emails show. Since then, 77,000 have died, some doctors resorted to homemade ones, and the mask machines in Texas stayed idle.”
Educated Guesswork: Adam Kucharski runs down some of the reasons why estimating rate of spread is hard.
Immunity: People with the disease seem to develop immunity.
Exit Strategy: The pessimistic view, as Conor Friedersdorf states it, is “the U.S. may have no treatment, no vaccine, and no ability to scale up testing and quarantining, due to technical hurdles or Trump administration incompetence or a lack of public buy-in.” * But optimists continue to try to make a containment strategy work. A paper by lead author Adam Kucharski discusses the “effectiveness of isolation, testing, contact tracing and physical distancing on reducing transmission of SARS-CoV-2 in different settings.” Kucharski summarizes one of the findings: “If individual-level transmission is particularly high in certain settings, it may point to interactions that could be changed to reduce risk. Reducing this potential superspreading could also enhance effectiveness of contact tracing.” * Jennifer Nuzzo points out that the amount of testing per capita is not a useful figure when we’re comparing countries with vastly different magnitudes of infection, e.g., South Korea and the United States.
Immunity Passes: The problem with giving people passes guaranteeing their immunity is that it would incentivize people to get immunity by intentionally getting infected. A possible solution is to let people get infected—in a controlled, doctor-monitored way with careful isolation.
Sweden: The country has suffered more deaths per capita than its neighbors. But Lyman Stone suggests this may partly be due to bad luck: “Sweden was already showing excess deaths before Norway went into lockdown.”
Children: A few children with COVID-19, at least 85 in the United States, get “multisystem inflammatory syndrome.”
New York: In New York City, 0.23% of the population has died of COVID-19. That’s 19,702 deaths.
Civil Disobedience: Colorado journalist Nick Puckett recorded a video today (May 10) from the C & C restaurant in Castle Rock showing a densely packed, wall-to-wall crowd, inside the restaurant, with a single person in the entire building wearing a mask—including staff. Someone independently posted a photo of the crowd to Facebook. The co-owner of the restaurant, April Arellano, also posted to Facebook a video of the crowd, a photo of a sign about opening, and an announcement about opening. I confess I found this shocking. The restaurant is certainly violating emergency orders and, I think, common sense. It seems like some people have already made up their minds that they’re all in on the herd immunity option. * The Denver Post put up an article about about the story. * Colorado’s state house minority leader Patrick Neville went to the crowded restaurant. * Puckett also wrote his own article about the event. One woman who visited the restaurant told Puckett, “I’m not afraid to be out. I’m not going to wear a mask. I’m healthy. I’m in good shape, and I don’t think it’s as serious as they say.” The problem is that young, healthy people who contract the virus without getting very sick still can spread it to others. * Update: The state suspended the restaurant’s license for 30 days. * See the follow-up story by the Gazette.
Antigen Tests: There are two basic sorts of tests: blood tests to check for antibodies and mucus tests to check for viruses. Mucus test samples can be collected by swabbing the nose or throat or by having someone spit in a receptacle. The key news of late is that the FDA has approved a new sort of mucus test for antigens. This contrasts with a PCR test, for “polymerase chain reaction.” I don’t really understand the mechanisms at work, but the process involves somehow duplicating the genetic material. The newly approved “diagnostic tests quickly detect fragments of proteins known as antigens found on or within the virus” (Sunny Kim). It yields faster but less-accurate results. Kim says there are more false negatives but a low rate of false positives. Depending on cost, it could be better to give someone a less-accurate test multiple times.
South Korea: “The Korea Centers for Disease Control and Prevention (KCDC) reported 34 new infections, the highest since April 9, after a small outbreak emerged around a slew of nightclubs, prompting the authorities to temporary close all nightly entertainment facilities around the capital. The death toll remained at 256.” Authorities are contemplating reopening schools. Again, it would kind of suck if your footnote in history was as a “superspreader”; here one nightclubber infected at least a couple dozen other people. * Michael Kim, and American in South Korea, explains a bit about South Korea’s strategy, including 14-day quarantine for new arrivals. * Vox’s April 10 video on South Korea’s strategy is useful. * “South Korean officials, after confirming their initial case, met promptly with medical-supply companies and urged them to develop test kits and start mass production.” * “South Korea slowly goes back to normal as schools reopen, sports games begin”
Herd Immunity: Karl Dierenbach suggests cocooning the vulnerable while fast-tracking everyone else to herd immunity as a possible least-bad approach. I’m skeptical for several reasons. First, I think it’s harder than he assumes to effectively cocoon the vulnerable. Second, I still hold out hope that test-trace-isolate can actually drive and keep effective rate of spread under 1. Third, it’s not just death we have to worry about, it’s long-term health damage. Even though most younger, healthier people won’t suffer such damage, some will.
Regulations: “Let small farmers sell meat to local grocers.”
Contagion: “A cluster of coronavirus cases in California was traced to a coughing patient at a birthday party.”
Civil Disobedience: After reopening briefly despite the shut-down order, California’s Cordair Art Gallery again shut its doors due to government threats.
Lockdowns: I’m finally getting around to reading Lyman Stone’s articles on lockdowns. (Stone is an American living in Hong Kong.) His basic position is this: “Lockdowns don’t work” (April 21). Stone is not saying that social distancing doesn’t work, nor is he saying that all government restrictions on social interactions don’t work. Here is the summary: “Many policies provide public-health benefits in pandemics, such as making facemasks mandatory, cancelling school, and banning large assemblies and long-distance travel. But ordering people to cower in their homes, harassing people for having playdates in the park, and ordering small businesses to close regardless of their hygienic procedures has no demonstrated effectiveness.” What is a “lockdown?” “Stay-at-home orders, low [single-digit] assembly thresholds, and business closures together constitute a lockdown.” Stone defines a “centralized quarantine” as one in which “individuals who test positive or individuals who have had contact with COVID-infected people are forced to be quarantined.” Here is a key line from the article: “Because COVID is an extremely severe disease that, if left unchecked, will kill hundreds of thousands of Americans, it is vitally important that policymakers focus their efforts on policies that do work (masks, central quarantines, travel restrictions, school cancellations, large-assembly limits), and avoid implementing draconian, unpopular policies that don’t work (lockdowns).” (Actually lockdowns have been pretty popular, but that’s because most people think they work.) Stone says that the burden of proof is on those who claim that lockdowns (on top of those other policies) do work, and he says there’s no credible evidence they do. From what I can tell, the argument for lockdowns was based on unrealistic modeling assumptions. Here is the part where I become a little skeptical. He offers as his examples of “successful control without lockdown” Sweden and the Netherlands. Here’s the May 9 data on deaths per million for the region: Sweden, 314; Netherlands, 313; Norway, 39; Finland, 47; Germany, 88; Denmark, 90. “Sweden is performing much better than the typical locked-down country,” Stone says, but I’m not sure that’s the relevant comparison. Stone, on firmer footing, points out that Hong Kong, Taiwan, and Korea successfully beat back the disease without lockdowns. However, I note, they had pretty extreme policies in other areas around contact tracing and quarantines. Impressively, Stone ran the numbers of U.S. counties and found no improvement with stay-at-home orders. . . .
. . . In an April 28 follow-up piece, Stone argues that “information can do what lockdowns can’t.” Contra the view that Americans are irresponsible, Stone writes, “Americans are a fundamentally conscientious people—and Americans took proactive measures to beat COVID long before government measures were in place.” Stone finds a very interesting fact: Social distancing in the U.S. began in earnest around March 11, when the NBA season was called off and Americans began to get serious about looking into the disease (as indicated by Google searches). Information from government seems to be important; “there’s good reason to think policy leadership really does matter.” This leads to a question: Don’t lockdowns (mainly stay-at-home orders) serve as important informational signals from government leaders? Here Stone makes an important concession: “Is it possible that while lockdowns do not influence the timing of social distancing, they do influence its scale? There is actually some evidence of this.” This could be either from the informational effect or from enforcement (likely both). However, the effects seem to vary widely by region: Some “SIP [shelter-in-place] states have less social distancing than any of the non-SIP states.” Stone cites an NBER paper finding “little evidence . . . that stay-at-home mandates induced distancing.” I’ll note here that, in Colorado, the governor explicitly said on multiple occasions that the state would not rigorously enforce the stay-at-home order, as he was depending on people’s good sense. Stone adds a really important point: Modest social distancing early in an exponential growth curves is better than severe social distancing late in the curve. Stone: “Had our leaders taken the threat seriously a month earlier, and communicated the risks to Americans more explicitly, COVID could have been a flash in the pan. Instead, many thousands of Americans are going to die unnecessary deaths.” He concludes, beating COVID-19 “won’t be achieved by the state making more regulations, but by diligent, conscientious citizens shouldering their personal responsibility to annihilate COVID through social distancing” and other measures. . . .
. . . In a May 5 piece, Stone lays out his case for central quarantines. One difference I seem to have with Stone is I think people often can be effectively quarantined in their homes, rather than in a government facility. Stone’s history of leprosy, the plague, and tuberculosis is fascinating. Here’s one detail I didn’t know: There’s a vaccine for tuberculosis, but not for leprosy or bubonic plague. Here’s where I get skeptical: Stone asks, “Why did we, instead of deploying a simple, easy-to-understand, low-tech solution [central quarantines] that any local government could have implemented, focus on a futuristic testing-and-trace regime that is never going to be fully deployable?” Isn’t the answer that asymptomatic spread of the coronavirus makes it really hard to know whom to quarantine? This is why I think we need all three pillars of test-trace-isolate to make any of them work (although there can be trade-offs between testing and tracing). Of course Stone recognizes that the Asian countries that used quarantines also used testing. I think, if we didn’t have testing capabilities, we’d simply social-distance ourselves slowly into herd immunity (which we may do anyway). Stone makes the following interesting point: “The existence of testing creates political demands for testing, and political opposition to dramatic measures aimed at people who have not tested positive.” The problem is we simply don’t have adequate testing capacity (yet?) to rely primarily on that. I’m not sure Stone’s critique of the “flatten the curve” approach is completely on-target. One purpose of “flatten the curve” was to prevent hospital overload (this is what Stone discusses), but another purpose was to allow governments time to ramp up test-trace-isolate capacity. Tragically, at least in the U.S., that capacity simply has not been expanded nearly enough. Stone thinks that that Western governments basically unthinkingly followed China into lockdown (although of course details varied). To get a handle on the scope of what Stone is talking about, he’s talking about “centralized quarantine sites for hundreds of thousands or even millions of Americans.” Again, I don’t see what advantage that has over simply isolating people who are likely sick in their homes in most cases.
Herd Immunity: Scott Gottlieb summarizes a study suggesting that “herd immunity could be achieved at a lower threshold than what’s typically assumed, because the most susceptible people are the ones who get infected first.” As Charlie Martin reminds us, on the Diamond Princess ship, “more than 700 people on board were infected” out of 3,711 passengers, or around a fifth. If most people are not very susceptible to getting the disease even if exposed, that’s a Very Big Deal. (See additional commentary about this for May 14.)
Supply Lines: “Farmers are euthanizing millions of animals that can’t get processed.”
Masks: Those send from China have been so bad the FDA has now banned them.
Government: Philosopher Onkar Ghate argues that the proper role of government regarding infectious disease is to stop infectious people from spreading the disease to others. I think that’s basically right, but the situation is complicated. To know who is infectious when asymptomatic people can spread the disease (as with COVID-19), government must have good capacity to test people. Of course this has been a huge problem for state governments (in the U.S.), because the federal government massively flubbed testing. So, when the testing is simply not available and the emergency is pressing, I don’t know what else a government is supposed to do other than impose large-scale restrictions on social interaction. (Ghate seems to agree some restrictions could be warranted, but I’m not sure exactly what he thinks about this.) Another complication is that the tests aren’t totally accurate. So often we’re dealing with degrees of likelihood that someone is infectious. And then testing may not even be the key issue. If someone has been exposed to a person known to be infectious, I think it’s reasonable to think that the exposed person has a high chance of being infected too. I think it’s reasonable for government to force into quarantine people who are likely infectious. Obviously it’s best if all contacts can also be tested. Of course this is all highly contingent on available technology; at the extremes, we can imagine that government has no ability to tell who is infectious or can perfectly tell who is infectious. So the facts on the ground matter a lot. * Ghate also discusses how, generally, level of expected harm, level of contagiousness, and means of infection (sex, breath, mosquito) plays into the proper government response. * He also says (and I totally agree) that government actions in emergencies should be spelled out more clearly ahead of time and not just left to arbitrary discretion of the leader of the day. He suggests that Sweden has relatively good law in this regard. * Ghate makes an interesting point about legal expectations: If businesses knew that they could operate in a pandemic only if they provided testing and such (and, I’d add, if they knew they wouldn’t get government bailouts), that would provide an enormous incentive for businesses to prepare for that eventuality.
Philosophy: Barack Obama blames a “selfish,” “what’s in it for me and to heck with everybody else” attitude for the Trump administration’s “chaotic disaster” regarding Covid-19. But there is a vision of rational self-interest that’s the polar-opposite of Trump’s anti-reason, tribal approach.
Antibodies: Some people are hopeful about antibody treatments, but they end to be difficult and expensive to produce (Jon Cohen, Science).
U.S. Plan: Megan McArdle expresses my fears exactly: “I . . . suspect that through stupid leadership, we may well have hit on the worst possible combination: economy-damaging lockdowns which weren’t used to create robust public health tools, followed by premature state reopenings with no real plan which will require steeper restrictions to control while having sapped the political will for those restrictions, resulting in the worst possible equilibrium: terrified people hunkered down in their homes, with just enough movement to keep outbreaks burning, and economic collapse.” Or, as Zoe McLaren summarizes, “Welcome to the pandemic yo-yo!”
Collateral Damage: Well Being Trust fears that, in the U.S., “additional deaths of despair [could] range from 27,644 (quick recovery, smallest impact of unemployment on deaths of despair) to 154,037 (slow recovery, greatest impact of unemployment on deaths of despair), with somewhere in the middle being around 68,000.” * COVID-19 could disrupt efforts to tame tuberculosis, potentially killing 1.4 additional people by 2025, says the UN’s Stop TB Partnership.
Social Distancing: A “shocking” two-thirds of New York COVID patients were practicing good social distancing. Matthew Fox explains why it’s not shocking: When most people are social distancing, even though spread among social distancers is lower, most people who get infected are social distancers. He offers the analogy of a vaccinated populace: If almost everyone is vaccinated, it will still be the case that most infected people will be vaccinated, even though the vaccine confers great protection.
Economy: Alex Tabarrock points out that disease spread within certain industries (meat processing) can severely harm economic activity.
Intentional Infection? An initial report claimed, “People Are Getting Sick After Going to ‘Coronavirus Parties.'” But apparently this isn’t well-substantiated. A May 6 NYT article reports, “Meghan DeBolt, the director of community health for Walla Walla County [Washington], said county officials were learning more about the cases that have emerged from the recent social gatherings. She said they were still hearing reports of parties where infected people were present but do not have evidence that the people who became ill after the gatherings had attended out of a desire to be exposed.”
Testing Model: Uh . . . “Why the porn industry has a lot to teach us about safety in the Covid-19 era” (Usha Lee McFarling, Stat). “Since the late 1990s, when an outbreak of HIV infections threatened to shutter the multibillion-dollar industry, the mainstream porn community has implemented procedures that require all performers to be tested for HIV and a host of other sexually transmitted infections every 14 days before they can be cleared to work.”
Spread: “A high plateau of new cases portends more spread.” The U.S. continues to have around 30,000 new cases and 2,000 new deaths every day.
Craziness: “Drive-through graduations, celebrations forbidden in Santa Clara County.” As Timothy Sandefur notes, “This is ridiculous.” * A person in Denver was ticketed for playing football. “He was playing football with another person and refused to stop,” a city spokesperson said. Mind-numbingly stupid bureacuracy. * A Colorado man “threatened ‘shooting’ and a ‘Civil War’ if public health officials didn’t lift the stay-home order in Denver’s suburbs.” * No, I don’t intend to watch “Plandemic,” but here’s an explanation. * “Armed activists escort black lawmaker to Michigan’s Capitol after coronavirus protest attended by white supremacists.” * A Canadian-born doctor treating U.S. coronavirus patients was denied permanent status as part of President Trump’s crackdown on immigration amid the pandemic.” * Uh . . . “divine intervention and supernatural turnaround” is not a plausible exit strategy.
Humor: Everyone is talking about the case for reopening Jurassic Park despite velociraptors being on the loose. (I suppose pointing out the disanalogies would be beside the point.)
U.S. Strategy: Andy Slavitt has a maddening Tweet thread about the U.S.’s utter failure to implement an effective test-and-trace strategy. The way I see it, we can do one of three basic things: Test-and-trace (at a large scale, recognizing we could lean more heavily on testing or on tracing); maintain relatively severe social distancing indefinitely, which is an economy-crusher; or suffer large numbers of deaths on the way to herd immunity. It seems to me we’re doing something like a combination of the final two approaches. Our policy disaster has compounded that of the virus. * See also Caitlin Rivers’s remarks on the need for testing and the false choice between health and economy. * On May 6, Donald Trump said, “”By doing all of this testing, we make ourselves look bad.” This is just shocking. The reason we “look bad” is that we’re doing massively too few tests.
South Korea: Meanwhile, life in South Korea starts to return largely to normal, with people going back to museums and such. Great video.
Tests and Regulations: Paul Romer suggests that FDA rules are getting in the way of ramped up use of saliva tests. Romer quotes rules as limiting tests to those who are symptomatic, as requiring the physical presence of a “trained healthcare provider,” and requiring nasal swabs. Romer also cites a paper “showing that saliva testing is better.” * “Why aren’t we doing this already? For one thing, it’s not exactly allowed. Group testing doesn’t fall within the manufacturer’s guidelines for use of the Covid-19 tests. Professor [Peter] Iwen’s lab had to get special permission from Nebraska’s governor” (Jordan Ellenberg). Carl Bergstrom comments on this report, “While some regulation may be needed to bad actors out of the supply chain, this is the sort of thing that is hampering the US response. We’ve been talking about this for over two months. During a pandemic crisis. We have to be nimbler.”
Testing: Some good news: “Per the Johns Hopkins coronavirus testing hub, the positivity rate of U.S. coronavirus tests appears to have fallen below 10% for the first time” (Dan Diamond). * “Harvard’s Global Health Institute proposes that the U.S. should be doing more than 900,000 tests per day as a country” (NPR). That translates to 2.7 tests per thousand people. As of May 5 the U.S. was testing 0.74 tests per thousand people. * “Scientists around the world are now testing sewage for the virus.”
Contact Tracing: It “can work—if we do it right. Some states, like New York, Massachusetts and California, are moving quickly to expand these services” (Tom Frieden and Kelly Henning).
Immunity: Carl Bergstrom summarizes an April 30 paper on immunity (in the context of broader information): “Now we know: 1) Most people who get COVID-19 produce antibodies. 2) From a separate study, most people who produce antibodies produce enough to confer some immunity. What we don’t know: 3) How long naturally acquired immunity lasts, and how that depends on disease severity.”
Herd Immunity: A short paper from Johns Hopkins (apparently dated late April) on herd immunity makes the excellent (I thought obvious) point that “herd immunity against COVID-19 will not be achieved at a population level in 2020, barring a public health catastrophe.” Unfortunately, the paper straw-mans variolation. It ignores: a) medically supervised variolation would tightly control the amount of the virus a person is exposed to, which likely would radically reduce risk, b) perhaps scientists could locate less-damaging variants of the virus for use, and c) higher-risk people would be screened out of the process, again radically reducing risks. The paper also claims, “To reach herd immunity for COVID-19, likely 70% or more of the population would need to be immune.” But reducing the effective rate of disease spread through moderate social distancing and improved public hygiene would reduce that fraction.
Damage: “Covid-19 wreaks havoc on many organs; inflammation and abnormal blood clotting are likely culprits.”
Masks and Prices: Economist Russ Roberts writes, “Price Gouging Could Actually Fix Our Face Mask Shortage.” He continues, “If you hold prices down artificially when masks are in high demand, you destroy the financial incentive to make more masks. You also destroy any incentive to create excess capacity or stockpiles for a future pandemic. . . . Markets are failing in America because we’re not letting them work. It’s not a market failure. It’s a policy failure. . . . If there’s fear of being accused of profiteering, there’s little incentive for the players within the supply chain to respond with urgency or to incur the extra costs of moving quickly.”
Social Distancing: Driving in the U.S. has been picking up since April 4, but it remains far below normal levels.
Sweden: “Its population density is about half that of Italy, and Sweden has a high proportion of single-occupancy households, and a relatively low proportion of multi-generational households,” notes Goldman Sachs.
Mutations: The Los Alamos National Laboratory put out a preliminary paper about a possible “more transmissible form” of the coronavirus. “The conclusions are overblown,” says Lisa Gralinski (May 6 story by Ed Yong for the Atlantic). Yong thinks that the virus has undergone some natural mutations but not enough to count as new “strains.” “I think the majority of people studying [coronavirus genetics] wouldn’t recognize more than one strain right now,” says Charlotte Houldcroft at the University of Cambridge (to Yong). Note: If it is not the case that scientists could find less-harmful variants of the virus, that would be a point against variolation.
Federal Response: “Hospitals and physicians around the country are sharply criticizing the federal government for the uneven and opaque way it is distributing its supply of the Covid-19 drug remdesivir” (Eric Boodman).
Treatments: “Treating Covid-19 patients with medicines to prevent blood clots might help reduce deaths in patients on ventilators, based on new observational data.” But Ashish Jha warns that these are “high risk therapies” and a randomized trial is needed.
Hospitals: “Nursing, and nurses, are not valued. It’s a shame, and maybe even a deadly shame, that hospital leaders don’t care about nurses like we care for our patients.”
I got way behind and today’s updates represent me taking a small step toward catching up.
General Observation: The fact that the dominant discussion in the U.S. is over the “tradeoff” of killing people or destroying the economy reflects the shameful failure to build robust capacity to test, trace, and quarantine (the likely sick).
Daily Deaths: Globally, daily death tolls have been jumping up and down on an overall slightly downward trajectory from the April 16 peak, with 5,903 deaths reported for May 6. The United States line looks similar, with 2,144 deaths reported for May 6. (Note: Our World in Data dates daily deaths early in the relevant day for the U.S.) Sweden has 85, South Korea 1, Japan 22, Germany 165, and Spain 185. Daily deaths in Spain (a country with around 47 million people) have fallen dramatically from its April 3 peak of 950.
Colorado: Governor Polis says residents need to maintain 65 percent less social distancing as the state partially reopens. * Colorado has suffered 921 related deaths to date. * Polis says, “We now have the capacity to process about 10,000 state tests each day in-state,” but I’m not seeing that in state data. According to the state’s COVID-19 page, on May 4, there were 3,080 tests (“may not include all negative results,” “includes only tests from labs that participate in electronic lab reporting”). The page says a total of 85,976 people have been tested to date.
Sweden Re: If Fraser Nelson is right, Sweden has gotten its effective rate of disease spread below 1 without the intense lockdowns of other regions (albeit with more upfront deaths). These stats are now a bit dated (April 29). But if this is accurate, and if it holds, it could mean good news for Sweden, as well as for Colorado, which seems to be following (not explicitly) Sweden’s model. Nelson quotes Johan Norberg: “The [London Imperial College] model could only handle two scenarios: an enforced national lockdown or zero change in behavior. It had no way of computing Swedes who decided to socially distance voluntarily. But we did.” But I fear Coloradans may be worse than the Swedes at voluntary social distancing and public hygiene. Of course we should take published estimates of R0 and effective R with a large amount of salt, as such things are hard to estimate.
Sweden Infection: Has a quarter of Stockholm’s population been infected, as Swedish officials say? Natalie Dean is skeptical. If a smaller portion of Sweden’s population has been infected, and if Sweden’s effective rate of spread goes and stays over 1 (it’s currently estimated to be under 1), that could spell a lot more pain for Sweden down the road. Those are both big “ifs.”
Hong Kong: Businesses have opened back up in Hong Kong, including restaurants, although measures regarding temperature checks, masks, sanitation, and distancing remain tight (David Leonhardt, May 6). Also, “Entrance to Hong Kong is limited mostly to residents, all of whom are tested and quarantined, even if the test is negative.” Takeaway: “Hong Kong’s strategy is working extremely well. It hasn’t reported a new homegrown case in more than two weeks. Over all, only about 1,000 people—out of 7.5 million—have tested positive. Only four have died.”
Canada: If we exclude New York, New Jersey, and Connecticut from the data set, Canada’s deaths per million is nearly as high as that of the rest of the U.S.
Africa: Why are COVID-19-related deaths in Africa apparently so low? I put my money mainly on the younger population and lower population density. Other candidate explanations include climate, less travel, and effective government response (which I find a bit hard to believe). One theory holds that greater exposure to other diseases (malaria, tuberculosis) somehow offers protection against the coronavirus; an alternate explanation is that those diseases kill the people who would otherwise be most susceptible to it. Or maybe Africans’ genes make them less susceptible, or maybe viral strains in Africa are less damaging. But at this point it seems theories are getting thrown against a wall. This disturbing report might reveal part of the story: “Tanzania’s government is covering up the true extent of the coronavirus pandemic with secret burials taking place at night.”
Lockdowns: A paper by Gregory Wellenius et al. suggests that “state-based policies have been effective in promoting social distancing in the United States.” See also Thomas Tsai’s summary. The paper finds “shelter-in-place mandatesprovided an additional 29% reduction” in mobility. Here’s the question I asked of Tsai: “How confident are you that the policies caused the changes in behavior, as opposed to policy and behavior changing with perceived risks? I’m trying to get a handle on the counterfactual ‘if there were no stay-at-home orders.'” Here’s his answer: “The hard part is that waves of social distancing all coincided around the same time. Our analysis of specific orders shows heterogenous effects—not perfect counterfactual but states that had multiple orders had larger mobility changes than states with single orders.”
R0 and Deaths: Michael Levitt’s “observation is a simple one: that in outbreak after outbreak of this disease, a similar mathematical pattern is observable regardless of government interventions. After around a two week exponential growth of cases (and, subsequently, deaths) some kind of break kicks in, and growth starts slowing down. The curve quickly becomes ‘sub-exponential.'” I have two basic comments here. First, the amount of overall growth has varied widely. Second, the eventual flattening can largely be explained by social distancing and public hygiene, whether mandatory or voluntary. Levitt doubts this second point. Levitt explicitly endorses the policy of herd immunity and sees “the standout winners as Germany and Sweden.” This immediately seems like a strange claim to me, given that Sweden’s deaths per million is 283, whereas Germany’s is 84. Sweden’s tests per 1,000 people is 15; German’s is 33 (May 3). (Germany’s total confirmed cases is much higher than Sweden’s, but this seems to be largely a matter of testing prevalence.) Most importantly, Germany led a “vigorous” response to COVID-19 relative to Sweden, albeit one dominated by test-and-trace.
Children: If children don’t spread the virus very much, it probably doesn’t make sense to keep schools closed. Emily Oster reviews available (limited) evidence indicating that children rarely get sick or even infected with the disease.
Outrages: Let’s call this what it is: manslaughter. Texas officials sent a pregnant woman “serving a two-year sentence for a nonviolent drug offense” to a prison knowing full well that she faced increased risk of contracting COVID-19. She died from it. * “States ordered nursing homes to take COVID-19 residents. Thousands died.” * “Native American health center asked for COVID-19 supplies. It got body bags instead.” * “2 teenage McDonald’s employees shot after 2 customers became angry that dining room was closed, OKC police say.” * Pennsylvania: “Man arrested after disrupting salute to first responders, waving gun, police said.”
I’m trying to catch up, so entries today include some older stories.
Collateral Damage: The UN’s April 15 report warns: “An estimated 4–66 million children could fall into extreme poverty as a result of the crisis this year. . . . Economic hardship experienced by families as a result of the global economic downturn could result in hundreds of thousands of additional child deaths in 2020, reversing the last 2 to 3 years of progress in reducing infant mortality within a single year.”
Regulation: “Well-intentioned government regulation systematically impeded disruptive innovation in the biosciences” (Michael Mandel, April 27). Mandel hopes the creativity unleashed during this period could lead to a Biotech Century.
Excess Deaths: “The United States recorded an estimated 37,100 excess deaths as the novel coronavirus spread across the country in March and the first two weeks of April, nearly 13,500 more than are now attributed to covid-19 for that same period, according to an analysis of federal data conducted for The Washington Post by a research team led by the Yale School of Public Health.”
Testing: Testing is pretty unreliable. I wonder why “we” don’t just rely more heavily on looking at people’s actual microbes with a microscope, hopefully using AI software to sort everything out? I ran across a 2009 article with some history of the use of electron microscopy in studying viruses.
Origins: “U.S. Secretary of State Michael Pompeo said ‘enormous evidence’ shows the novel coronavirus outbreak began in a laboratory in Wuhan, China, but didn’t provide any proof for his claims.” I remain highly skeptical, especially given the political convenience of the claim.
International Comparisons: Amesh Adalja offers some good discussion of approaches in South Korea, Sweden, and elsewhere (May 1 interview with Yaron Brook). Adalja discusses Taiwan as a success story (around the eleven-minute mark). Johns Hopkins released an April 25 interview with “Taiwan’s Vice President Chen Chien-jen[, who] received a Doctor of Science degree in epidemiology and human genetics from the Johns Hopkins Bloomberg School of Public Health in 1982.” Adalja does not think that different strains of the virus are responsible for different death rates in different regions; rather, he looks to differences in demographics. Adalja also says he thinks the CDC was sidelined, its early warnings unheeded.
Colorado Regulations: As Rob Natelson points out, no normal person could possibly hope to fully understand the vague, complex, overlapping, constantly-changing public health orders in Colorado.
Denmark “says coronavirus spread has not accelerated since reopening began.” Our World in Data has Denmark’s peak daily death toll at 22 on April 5, and it shows the daily confirmed cases also as level (below the peak). The effective R remains below 1, officials say. What exactly did Denmark reopen? Business Insider says “schools for children up to age 11,” “courts, beauty salons, and hairdressers.”
Controls: Repeal the Defense Production Act. * Justin Amash wants to “get government out of the way of farmers who want to sell meat directly to consumers, restaurants, and grocers within their state.” (I’m not sure exactly what those barriers are.)
Smoking: The news about smokers and COVID-19 leaves me scratching my head. Jason Kiddle offers one theory as to why smoking might actually reduce susceptibility to COVID-19: “One possible explanation is that smoking results in increased production of nitric oxide within the nasal passages, which have the important role of cleaning and filtering the air prior to it being pulled down to the lungs. This first pass exposure to nitric oxide in the nose may be key to preventing infection. This gas has been shown to block the ability of SARS-CoV-2 from entering cells as well as impair the ability of the virus to replicate once inside the cell.”
Reopening Anyway: “Shelter-In-Place Is Ending, Whether Governments Want It To Or Not” (John Koetsier). “Apple’s Mobility Trends report shows that traffic in the US and other countries like Germany has pretty much doubled in the past three weeks.” Politicians should make plans compatible with real human behavior. * Elon Musk is perhaps indicative of some people’s stir-craziness; “give people back their goddamn freedom,” he says.
Herd Immunity: Beyond the question of whether controlled herd immunity is the optimal strategy is the question of whether herd immunity is inevitable, whether or not it is the conscious goal, whether it is reached in a controlled or chaotic way. Some people are already talking like it’s inevitable. “‘This pandemic is not going to settle down until there is sufficient population immunity,’ slightly above 50%, epidemiologist Gabriel Leung of the University of Hong Kong told a New York Academy of Sciences briefing” (Sharon Begley, May 1). I don’t know whether it’s inevitable. But what seems obvious is that, if herd immunity is or becomes inevitable, it’s a lot better to reach it in a controlled, least-damaging way.
Herd Immunity: Carl Bergstrom and Natalie Dean have a nice discussion of many of the implications of herd immunity, which they warn against. But I think there are four main problems with the piece. 1) It is questionable to extrapolate from the experiences of smaller Asian nations and island nations (South Korea is practically like an island nation) to the much larger United States with its diverse, open, and independent population. 2) It’s all well and good to talk about theoretical containment strategies, but we need actual tools that actually work for a given region. To date, the test-and-trace strategy in the United States has mostly been a massive failure. Perhaps that will still change. 3) As Bergstrom and Dean note, a lower rate of spread reduces the fraction of the population that must be infected to reach herd immunity. But they don’t acknowledge the obvious implication that we could reach herd immunity in a less-damaging way by keeping effective rate of spread relatively low through moderate social distancing, limited test-and-trace, and increased public hygiene. 4) The authors don’t even mention the possibility of variolation, which obviously would dramatically reduce the pain of reaching herd immunity. (See my previous discussions of this.) See also Dean’s Tweet thread on the broader topic.
Sports: I just Tweeted: Idea for professional sports in the era of COVID: If you can’t fill stadiums, put some fans on Zoom or the like so you can broadcast their background cheering. Otherwise stadiums will seem bizarrely quiet. (They could even pipe the cheering over speakers at stadiums.)
Antivirals: “FDA grants remdesivir emergency use authorization for COVID-19.”
Colorado: I argue that Colorado is headed toward a strategy that looks something like Sweden’s, with the focus on slowing spread of the disease to not overblow hospitals but accepting the possibility of eventual herd immunity.
Collateral Damage: Dr. Jeffrey Singer discusses the “steep costs of delaying and denying elective surgery and other care.”
Reinfection: Did infected people in South Korea recover and then get reinfected? It was never plausible that a person developed sufficient antibodies to recover from COVID-19 but then almost immediately lost those antibodies. So why did testing seem to indicate that’s what happened? “The positive test results were likely caused by flaws in the testing process, where the tests picked up remnants of the virus without detecting whether the person was still infected.”
May 1 (Lots of news today but I was too busy to get to most of it.)
Private Response: “Nike turned shoe parts into face shields in just two weeks.”
California: Orange County Sheriff Don Barnes is critical of the governor’s beach shut-down. “I implore the Governor to reconsider his action and work with local authorities, allowing us to address the few while not penalizing the majority.”
Intimidation: Okay, heavily armed people pushing their way into a state capitol, as they did in Michigan, definitely crosses a line. This “protest” clearly was intended to intimidate government officials. See photos by Michigan State Senator Dayna Polehanki and by Jeff Kowalsky.
Lab Grown? Honestly I’m surprised to see the U.S. government and a major media outlet take this story so seriously. But here it is: “The U.S. Defense Intelligence Agency updated its assessment of the origin of the novel coronavirus to reflect that it may have been accidentally released from an infectious diseases lab” (Newsweek, April 27). This comes surprisingly late in the story: “To be sure, there’s no evidence that SARS-Cov-2 came from the Wuhan lab, nor that the virus is the product of engineering. Most scientists believe, based on the evidence available, that a natural origin is the most likely explanation.” Meanwhile, Dan Kaszeta makes the case that the coronavirus is not a biological weapon or even human-made. Surely that must remain the default position.
Colorado Update: The latest numbers from the state: 72,390 tested; 15,284 cases; 2,697 hospitalized; 777 deaths. That would yield a case fatality ratio of 5%, although both the true infection rate and the true death count are highly uncertain. Governor Polis released his April 27 case for implementing “safer at home” (following stay-at-home). See also Polis’s media conference and press release. Notably, Polis’s plan explicitly calls for an effective R0 of between 1 and 2, meaning the disease will continue to slowly spread. How is herd immunity not the endgame of this? In other words, this has essentially turned into the Swedish model, it seems to me.
Rat Patrol: “Denver’s stay-at-home order enforcement teams aren’t letting up, with 23 businesses cited so far.”
Testing: Tomas Pueyo’s testing plan is significantly different from Paul Romer’s plan. Whereas Romer wants to test (most) everyone regularly, Pueyo wants to test everyone with symptoms plus everyone those people came into contact with. As Pueyo acknowledges, his plan calls for very-fast testing and fast and effective contact tracing (with follow-up testing). So this plan reduces the need for so many tests but makes the test-and-trace ground game really important. I was struck by Pueyo’s warning at the end of the piece: “Most countries are not approaching the Dance well. If they continue their current path, they will end up like Singapore.”
Sweden: Nils Karlson, Charlotta Stern, and Daniel Klein explain Sweden’s approach. “Within Swedish culture, people trust one another to behave in a responsible way and respect others. Moreover, they usually trust their authorities, not only politicians but also the public administration. ‘Recommendations’ are taken seriously. Rarely do the authorities cry wolf, and so when they do, people respond.” “There have not been official pronouncements about herd immunity, but it is likely part of the broader strategy.” Of course a consequence is higher death counts than some neighboring nations. * Even the New York Times concedes, “Sweden does seem to have been as successful in controlling the virus as most other nations. Sweden’s death rate of 22 per 100,000 people is the same as that of Ireland, which has earned accolades for its handling of the pandemic, and far better than in Britain or France.” State epidemiologist Anders Tegnell “denies that [herd immunity] was ever the government’s policy,” and it’s not clear (to me) whether Sweden will reach it (although something like a fourth of the population may have already been infected). * Thomas Friedman also discusses Sweden: “The result, so far, Tegnell noted, has been a gradual building of herd immunity among those least vulnerable while the country has avoided mass unemployment and an overwhelming of the hospital system.” * See Tegnell’s comments published in USA Today. * Obviously Sweden will still suffer enormously economically; Sweden’s central bank estimated a contraction of GDP by around 7 to 10 percent.
Japan: The country seems to be doing okay with high levels of voluntary social distancing, few compulsory measures, and “limited testing” (New York Times, April 27). Or maybe not. Abigail Leonard’s April 24 article tells the story of “Japan’s northern island of Hokkaido,” which did three weeks of lockdown, followed by 26 days of loosening, followed by another round of lockdown. To me this illustrates the problems of trying to sort out effects of national orders, regional orders, and the many factors that have nothing to do with orders. And of course what might work on island nations (or regions thereof) may not work elsewhere.)
Effects in Children: “Over the last three weeks, there has been an apparent rise in the number of children of all ages presenting with a multisystem inflammatory state requiring intensive care across London and also in other regions of the UK.” This condition might be related to COVID-19. Such severe symptoms remain “very rare” in children (Nursing Times, April 27).
Civil Disobedience: Quent and Linda Cordair say they’re opening their Napa Valley art gallery (where I’ve done business) regardless of the rules. They note that disease and death counts are low in their area. They write, “We must get back to work, back to living, as well and as quickly as possible, while continuing to observe reasonable precautionary measures. It’s time.” See the related news article. The Cordairs got a shout-out from the Objective Standard.
International Comparisons: Hassan Valley reviews the strategies for six regions. Some regions that delayed strong controls suffered high death counts (Italy, New York, United Kingdom). On the other hand, New South Wales, Australia, quickly implemented strong controls and slowed the spread of the disease. Singapore had to clamp down fairly late (38 days in) due to increased spread. Relatively open Sweden saw relatively high death counts but relatively low and dropping disease spread. What I think this indicates is that things other than controls made the bigger difference, things such as density and international travel.
Vaccine: The good news: “Potential coronavirus vaccine being tested in Germany could ‘supply millions’ by end of year.” The bad news: “The grim truth behind this rosy forecast is that a vaccine probably won’t arrive any time soon. Clinical trials almost never succeed. We’ve never released a coronavirus vaccine for humans before. Our record for developing an entirely new vaccine is at least four years.”
Camera Eye: Florida reporter Vic Micolucci has a great post (April 19) about how different camera angles can make a beach appear more or less crowded.
Impact of Lockdowns: Erik Brynjolfsson presents a chart (via OpenTable) claiming that “the day before closures, restaurant reservations had fallen 73 percent on average.” David Boaz shows the same chart via Free Beacon. Adam Ozimek provides a comparable chart (also via OpenTable data) showing pretty dramatic city-by-city decline in customers prior to formal shutdowns. A person could look at these charts and draw very different conclusions: Either “the lockdowns aren’t what caused the economy to contract” or “the lockdowns weren’t necessary.” Of course, we need to watch our language here: I’m thinking of “lockdowns” in terms of stay-at-home orders and the like.
Excess Deaths, Colorado: From February 1 to April 11, Colorado had 429 confirmed COVID-19 deaths but 905 “excess deaths” (Westword).
Testing, Colorado: Colorado seems to be on track to expand testing as much as five-fold, from around 2,000 to 10,000 tests daily. More is better, obviously. But to shift primarily to a test-trace-isolate strategy, we need something like a hundred-fold increase. Paul Romer calls for testing everyone (let’s say everyone with public exposure) at least once every two weeks. From what I can tell, Colorado simply is not on track to limit spread of the disease to a minority of the population. The likely outcome, I think, is that we continue to keep the economy largely suppressed even as we slowly move to herd immunity.
Sweden: Jennifer Kasten summarizes the approaches of Sweden and Norway. She summarizes: “Current epidemiology scorecard: Norway by a mile. Not even close. Sweden had 1.4x as many cases per million, 6.4x as many deaths per million.” But it seems to me that any such comparison is necessarily premature. If Sweden achieves herd immunity and Norway does not (a real possibility), then Sweden will remain relatively open in relative safety, whereas Norway will have to cope with the threat of disease spread, indefinitely (until there’s a vaccine). Plausibly, Sweden is taking its lumps early, and others are delaying taking their lumps. Checking the score in the middle of the “game” is interesting, but I’m more interested in the final tally.
“Excess” Deaths: One of the big discussions in recent days is about how comparisons of total deaths, relative to comparable time periods in previous years, indicate a lot more deaths than are explained by official COVID-19 death stats. This implies one of three things: COVID-19 is causing those extra deaths even though they’re not officially recognized, the socio-economic fallout of COVID-19 is causing those extra deaths (e.g., by many people not seeking medical care for other problems), or (likely) some combination of those factors is causing the extra deaths. Jacob Sullum offers some relevant links and commentary. A key underlying consideration here is that the data simply are drastically incomplete.
Historical Comparisons: CDC has a nice page about the 2009 H1N1 Pandemic. “From April 12, 2009 to April 10, 2010, CDC estimated there were 60.8 million cases (range: 43.3-89.3 million), 274,304 hospitalizations (range: 195,086-402,719), and 12,469 deaths (range: 8868-18,306) in the United States due to the (H1N1)pdm09 virus.”
Social Distancing, Imperial College: Arguably the single most influential paper written about COVID-19 was London Imperial College’s March 16 Report 9, “Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand” (lead author Neil Ferguson). Given that much of the world has now implemented much of that playbook, I thought it would be useful to look back at what the report claims. Here is the paper’s key policy conclusion:
We show that in the UK and US context, suppression will minimally require a combination of social distancing of the entire population, home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures, though it should be recognised that such closures may have negative impacts on health systems due to increased absenteeism. The major challenge of suppression is that this type of intensive intervention package–or something equivalently effective at reducing transmission–will need to be maintained until a vaccine becomes available (potentially 18 months or more)–given that we predict thattransmission will quickly rebound if interventions are relaxed. We show that intermittent social distancing –triggered by trends in disease surveillance–may allow interventions to be relaxed temporarily in relative short time windows, but measures will need to be reintroduced if or when case numbers rebound.
The paper contemplates a large reduction in social contact under the proposal, “Social distancing of entire population.” It states, “All households reduce contact outside household, school or workplace by 75%. School contact rates unchanged, workplace contact rates reduced by 25%. Household contact rates assumed to increase by 25%.”
Exit Strategy: “We need more targeted approaches to contain high-risk activities and protect high-risk populations while giving ordinary Americans more—not less—freedom to figure out when and how they want to return to work and some semblance of normal life” (Shikha Dalmia).
Variolation: William Cullerne Bown has up an April 29 paper.
Herd Immunity: David Katz explicitly calls for herd immunity as a conscious goal. He also makes the common-sense suggestion that people try to improve their general health.
IFR Estimates: I’m reading an older (March 21) document by Richard Salsman, which prompted me to take another look at claims of the infection fatality ratio made by London Imperial College. Here’s what Salsman says: “Initially, according to an influential but catastrophist study from London Imperial College, which was widely promulgated by the World Health Organization (WHO), COVID-19 was estimated to have a global death rate of 3.4% for those eventually infected, peaking in mid-2020.” I find the 3.4% figure coming from the WHO in early March. I also find Christl Donnelly of Imperial College explicitly saying on March 4 that the estimated case fatality ratio was 3.4% while the estimated infection fatality ratio was 1%: “This is lower than the observed 3.4% figure because asymptomatic and mildly symptomatic cases are included in the denominator.” The Imperial College’s March 16 paper lists an “adjusted” IFR as 0.9%. This is not the only error in Salsman’s paper. He cites a “0.1% historical death rate for those who contract the common flu each season,” which squares with other sources, but then says, “The death rate from H1N1 (0.02%, or total deaths divided by total infected) was twice the long-term average death rate of the common flu, but still miniscule.”
Disease Damage: COVID-19 seems to cause some severe neurological problems (Science Alert, April 27). Of course stroke and brain swelling and inflammation can cause neurological damage, and COVID-19 can cause those things. More subtly, the disease seems to provoke something akin to an auto-immune disorder in which the immune system attacks the nerves. (See the related note in the New England Journal of Medicine.) However, the following line is misleading: “Some studies report that over a third of patients show neurological symptoms.” What does “patients” mean here? As the relevant article from the American Medical Association explains, “In a case series of 214 patients with coronavirus disease 2019, neurologic symptoms were seen in 36.4% of patients and were more common in patients with severe infection (45.5%).” Obviously this group is not representative of everyone infected by the virus. Just as obviously, the findings are quite concerning.
Collateral Damage: “Breast cancer surgery, it turns out, is considered an elective procedure—now put on hold as hospitals focus on COVID-19 cases” (Joanne Lipman, April 6). This article (which I just saw) raises (at least) a couple of questions. First, how widespread is or was this phenomenon of surgeries getting cancelled that most people would regard as “very important?” Second, what was the relative impact on such decisions of medical pronouncements (the piece mentions “the American College of Surgeons called on physicians to halt nonessential procedures” on March 13), and individual hospitals worrying about shortages of protective medical gear? Regardless, it seems obvious that these delays will result in more health problems and more death down the road.
Testing: “Universal COVID-19 [antibody] testing in San Miguel County hits delays” (April 27). Disappointing.
Exit Strategy: Here’s how I responded to Jason Crawford’s remark that “herd immunity = giving up.” “Here’s how I see it. If we can still massively ramp up testing such that we can largely reopen with test-trace-isolate, that’s best. But we’re way behind. Short of that, controlled herd immunity beats keeping the economy largely on ice indefinitely.” (I think variolation could play an important role in reaching herd immunity in the least-damaging way; see my previous article and further notes.)
Lockdowns, Erickson and Massihi: April 27: “The American College of Emergency Physicians (ACEP) and the American Academy of Emergency Medicine (AAEM) jointly and emphatically condemn the recent opinions released by Dr. Daniel Erickson and Dr. Artin Massihi.” (Hat tip Paul Hsieh.) Unfortunately, this statement doesn’t actually explain what those doctors said or what’s wrong with what they said. As of April 27, a video released by those doctors had been taken down by YouTube. Erickson appeared on Good Morning San Diego on April 27 to explain his views. Offhand I didn’t hear him say anything on that program that’s obviously crazy. His basic position is that regions where the disease has not spread much probably should reopen quicker. The American Institute for Economic Research has part of the the original video transcribed. I do think the remarks in that video play a little fast and loose with extrapolations, and they make the basic mistake of not adequately taking into account the effects of social distancing. Yaron Brook agrees with some of the doctors’ policy conclusions but criticizes the way they handle the data. Erickson makes three main bad moves: He treats unrepresentative testing results as representative, and he ignores the trajectory of the disease, and he ignores the effect of social distancing on the trajectory of the disease. An article by the Orange County Register notes the doctors’ claims are “riddled with statistical errors.” David Gorski also wrote a take-down of the doctors’ claims, saying they promote “dangerously bogus pseudo-epidemiology about COVID-19.” Jennifer Kasten also critiqued the doctors’ claims in an April 26 Facebook post. Among other things, she points out that the claim that that quarantine undermines people’s immune systems is silly, as there are pathogens everywhere. (However, I do wonder if this point applies equally to newborns, especially if kept indoors a lot more.)
Media, radio: Staff with Peter Boyles’s radio show report “massive furloughs” in radio. See also my April 27 article, “News media need creativity amidst destruction.” The Poynter Institute has a lengthy list of “newsroom layoffs, furloughs and closures caused by the coronavirus.”