What US Government should do regarding Covid-19

This is (by far) the best document I have seen on what to do on the medical side.  It is about 3 pp. long and I believe it will be updated periodically.  Excerpt:

  • Consider guaranteeing top tier treatment and ICU beds for people directly working on treatments or vaccines. We need to keep relevant science labs open. (They’re likely to be closed as things stand.)
    • No doubt logistically challenging but may be necessary. Can you get scientists to keep going without this?
  • Announce $10B prizes for first vaccine and for first cure.
    • Think about mechanics. Should there be awards for second place, too? How should collaboration be factored in?
  • Issue $1B of research grants to all competent labs and organizations that could plausibly use them. They just have to report on progress every 30 days and require that they actively share all progress with other labs.
    • Proposed structure: $100M to each of 5 companies.
    • $10M to each of 40 labs.
      • Remainder based on discretion.
    • Take what’s required for treatment cases and make an “open source” version whose bill of materials costs less than $1,000. Commit to purchasing at least 100k. Even if US turns out not to need them, donate to other countries.

The author is anonymous, but I know that he/she has followed the issue very closely from the beginning, and his/her predictions have been largely on the mark.  If you are in USG I am happy to put you in touch, just write me.

Again, here is the document, highly recommended.

Comments

Would the our government award the prize or research grants to a foreign government or government sponsored lab.

By the way, if this is a subtle way to get funding for a proposal you plan to make, I demand payment.

By this I mean, if my comments improve your proposal, I demand payment for the comment and its contribution.

After all, there is no such thing as a free good.

Also, is there a requirement to disclose how this information is to be used or shared with others and it's intended purpose? Do University disclosure rules apply to subjects answering these questions?

But your idea is useless because it needed to be funded 20 years ago.

My idea is the prize must be awarded for a time that gives funding borrowed from savers from 20 years in the future to scientists 20 years in the past who have provided the vaccines to prevent all viral pandemics today, thus preventing this issue being debated.

Nah, we'll just buy the lab. https://www.cnbc.com/2020/03/15/coronavirus-germany-tries-to-stop-us-luring-away-firm-seeking-vaccine.html

Let's see if there could be a prize so that America can at least match this country's preparedness - "Ominously, there are far fewer hospital beds per capita in the US compared to the Lombardy region in Italy, where the coronavirus has overwhelmed the healthcare system.">

Guardian - The Trump administration has offered a German medical company “large sums of money” for exclusive access to a Covid-19 vaccine, German media have reported.

The German government is trying to fight off what it sees as an aggressive takeover bid by the US, the broadsheet Die Welt reports, citing German government circles.

The US president had offered the Tübingen-based biopharmaceutical company CureVac “large sums of money” to gain exclusive access to their work, wrote Die Welt.

According to an anonymous source quoted in the newspaper, Trump was doing everything to secure a vaccine against the coronavirus for the US, “but for the US only”.

"According to an anonymous source" So, likely the exact opposite of the report then. I could imagine him offering to buy the cure, but there would be no benefit in keeping it for the US only.

More from that clearly poorly researched article.

When approached about the report by the Guardian, the German health ministry would only confirm the accuracy of the quotes attributed to one of its spokespersons in the article.

“The federal government is very interested in vaccines and antiviral agents against the novel coronavirus being developed in Germany and Europe,” the spokesperson quoted in the original article had said. “In this regard the government is in an intensive exchange with the company CureVac.”

The German health ministry spokesperson declined the opportunity to correct any inaccuracies in Die Welt’s account.

With its headquarters in the south-western German city of Tübingen, CureVac also has sites in Frankfurt and Boston in the US. Linked with the German health ministry, it works closely with the Paul Ehrlich Institute, a research institution and medical regulatory body that is subordinate to the German health ministry.

For the German readers, the source of the Guardian article - welt.de/wirtschaft/article206555143/Corona-USA-will-Zugriff-auf-deutsche-Impfstoff-Firma.html

Exclusive here probably means you have to buy the exclusive rights to the USA market...so its not Trump wanting to control the product, but the firm wanting to sell off the rights to the US market.The journalist twists the words to make it seem nefarious.

Trump is once again engaging in socialism. The US government should not be paying for stuff like this. Trump could use all that free government money to buy rights to my next movie.

Emergent Venture journalism awards should go to the journalists/outlets who first (and most widely) publish this list of action items. The inability to discern expertise is a substantial problem in US media, and highlighting recommendations like this would be a test of quality. My view as an economist who studies news markets is that outlets face too many incentives to produce "more" content/words/articles. What we need now is for the "share" of substantive information to rise so that junk does not crowd out good ideas.

Would the contest interfere in any way with existing government programs and efforts that did not offer an award or prize.

Full containment now. Repurpose tens or hundreds of thousands of gov’t employees to contact tracing. Close everything.

LOL. People still think you can contact trace this?

China had to impose a racist policy against anyone from Hubei. They were beaten in the streets of other provinces.

Are you saying anyone from Washington state needs to be quarantined?

> Are you saying anyone from Washington state needs to be quarantined?

Yes. Also, we should do something about the coronavirus.

Of course you can trace it. Your phone knows where you've been. Whether the government has a right to that data is worth a debate though.

Is still irrelevant in anything to do with American health care, apparently, since even tens of billions is apparently chump change.

Think big - why not award a 1 trillion dollar coin as a prize?

The underlying assumption - that only a cash award can properly incentivize a threat to humanity - is absurd and offensive.

You must be new here.

Agreed.

Get me the name of any drug company that has a good idea for a vaccine and is sitting on it.

Of course not.

By the way, the market works for this: If you have an idea, you can license it to someone else who has the capability or capacity to carry it forward.

That's not to say a crowdsourcing/crowdlearning exercise is bad. It may draw out a flukey idea that deserves consideration.

But, what if the government gets inundated with flukey ideas and plans in its review process and overlooks the most promising project already in the pipeline or one that would have been in the pipeline but was delayed because flukey proposal are being reviewed.

This project assumes there are qualified persons to review the proposals and that there efforts will not be taken off other more viable projects.

That is a silly comment. To do any work in this field requires hiring a number of people, getting equipment and buying supplies.
Depending on what you are doing you might need an isolation lab facility, which is very expensive.
If you have all this stuff and are doing something else, that needs to continue. More people have died from heart disease in the US since the beginning of this thing than coronavirus. You can't simply repurpose your resources.

Another thing might be to quickly set up a manufacturing facility for the chemicals and supplies that research labs like this would require.

Bill: Sorta like telling that Seattle researcher not to work on her test, it is too confusing?

Derek, They had no difficulty in choosing to work on the test.
Your statement is not logical.

If it turns out that no company can develop a vaccine, what have we lost with the prize idea? And I would certainly pay the prize to foreign researchers as well, why not?

There are two instances where I could see a prize being valuable, but they would not be what you are thinking of:

1. Covid takes its course through the population, and the drug comes out after the pandemic is over, or it looks like it will be over soon, and the costs of continued development don't make it worthwhile going forward.

2. The prize attracts flukey ideas that would not otherwise been accepted by the drug company or institution, because the probability of success was very low. But, the prize value is high, so you work on a project that uses resources for another drug so that you can get the prize.

3. The prize might be valuable for development after the covid viruses attacks most of the population and possibly peters out. In that case, there, but for the prize, the firm would continue to develop a drug.

From the Guardian -

The Trump administration has offered a German medical company “large sums of money” for exclusive access to a Covid-19 vaccine, German media have reported.

The German government is trying to fight off what it sees as an aggressive takeover bid by the US, the broadsheet Die Welt reports, citing German government circles.

The US president had offered the Tübingen-based biopharmaceutical company CureVac “large sums of money” to gain exclusive access to their work, wrote Die Welt.

According to an anonymous source quoted in the newspaper, Trump was doing everything to secure a vaccine against the coronavirus for the US, “but for the US only”.

From the Guardian -

The Trump administration has offered a German medical company “large sums of money” for exclusive access to a Covid-19 vaccine, German media have reported.

The German government is trying to fight off what it sees as an aggressive takeover bid by the US, the broadsheet Die Welt reports, citing German government circles.

The US president had offered the Tübingen-based biopharmaceutical company CureVac “large sums of money” to gain exclusive access to their work, wrote Die Welt.

According to an anonymous source quoted in the newspaper, Trump was doing everything to secure a vaccine against the coronavirus for the US, “but for the US only”.

Guardian - The Trump administration has offered a German medical company “large sums of money” for exclusive access to a Covid-19 vaccine, German media have reported.

The German government is trying to fight off what it sees as an aggressive takeover bid by the US, the broadsheet Die Welt reports, citing German government circles.

The US president had offered the Tübingen-based biopharmaceutical company CureVac “large sums of money” to gain exclusive access to their work, wrote Die Welt.

According to an anonymous source quoted in the newspaper, Trump was doing everything to secure a vaccine against the coronavirus for the US, “but for the US only”.

Again, the journalist is garbling the story, on purpose.

Negotiating the USA market rights...you pay for exclusive rights.

Trump admin. is not buying global exclusivity.

Government buys the rights and then gives it to all vaccine producers.

Talk about a silly mistake - sorry.

Unfortunately for prior_approval/clockwork_prior here, a terminated former employee at George Mason University, there is no vaccine for autism.

Furious at his termination in the 70s or 80s, he became an expat and has lived in Southern Germany for decades. Every day for 20 years he has trolled this blog as a form of pseudo revenge against the University that fired him for incompetence.

Apparently Germany has no mental healthcare facilities. And the US ain’t sending our best....

I have read that this former GMU employee was fired 30 years ago for either sexual harassment or sexual assault.

In the spirit of the metoo movement, I think that should be noted every single time you identify this person. Personal courage is important - people who have personally experienced sexual harassment or sexual assault, possibly including yourself in such a traumatic situation, need to be supported unconditionally.

You cannot even keep your story straight from post to post - do you have any clue just how silly that makes you look, apart from showing sheer incompetence when it comes to making things up.

What should the government do? Not set a bad example of unnecessary testing for people showing no symptoms comes immediately to mind.

Or not create impromptu situations like this one - "Trump’s Wednesday night announcement about the travel ban quickly sent European airports into chaos, even as officials clarified that it was far narrower than the president initially suggested. American citizens, permanent residents and their immediate families would still be allowed to fly home.

On Saturday, social media filled with scenes of chaos at the 13 U.S. airports where authorities say all Americans flying home from Europe are now being routed. Photos captured clogged hallways and standing-room-only lines as airports apologized for the delays, attributing them to new screening measures."

There are good arguments for _randomized_ testing of asymptomatic people, and in fact some hospitals have already started implementing that across their whole patient population (swap and test one out of every , say, 20 patients, completely randomly no matter what they're at the hospital for). Extremely useful data can be gathered from that sort of sampling approach.

clogged hallways, wow. end times

Simply a scene of the disease spreading among Americans as one can safely assume that some of those people are carrying covid-19.

People who likely would not have been arriving all at once and overcrowding facilities in the U.S. Both at the airport, and a likely much smaller subset, a few days later in American hospitals.

Wait, what, Tyler's advocating for governments to manipulate the markets?

Pandemic is the type of situation that Sun Tzu talks about.
"Every battle is won or lost before it's ever been fought".

A $10B prize? Like $9B or even $2B wouldn't suffice? Geez.

It's a full embrace of Casino Capitalism.
The prize isn't meant to address costs or values, it's meant to get as many rats running the race as possible.
And there for meant to punish as many unlucky rats as possible.

Why is it punishing of unlucky rats? Drug companies who enter the race to develop a vaccine would knowingly take the risk of failure, just like every other drug that is developed.

Say it like this, 10 beellion dollars.

OK, let's look at the prize economics.

1. Say you are currently conducting research for a drug. You have a budget and a plan, it has been approved by management, you are going as fast as you can because you see the potential of making future sales.

What does the prize add?

2. Let's say you have a project that has been rejected by management but you think it is worthy. You now convince your boss to go ahead.

Your project has a 50/50 prospect. And will cost (you put in the number)

But, there are other persons who are also in the market: including, government funded labs, other competitors, and your prospects of winning the prize are uncertain.

After all, first vaccine and first cure can be done by anyone in this market.

Would you bet. Would you go forward.

3. Now, let's change a parameter: persons who are currently in the innovation market doing research to do a cure, based on their confidence and business plans approved months ago, come in first.

Do they get the prize? If they do, it was a gift.

4. Who get's the Intellectual property rights of those who accept the challenge? Notice that the prize is conditioned on disclosing information to the prize granting entity.

Can the prize granting entity use the information for itself, share it with others?

OOPs, I noticed that the title says "What the Government Should do"...so that means the prize granting entity is the Government. Well, that changes some things, as federal regulations probably govern disclosure, ownership and licensing of information.

But, since it does involve the Federal Government, the first question to ask is: Why isn't the existing federal program working and why is this better. Progress and disclosure rules I would imagine already exists within the current federal structure. What is probably different is that there is mandated sharing with others at the discretion of the agency.

I apologize for not reading the word Government in the Title.

Bill, yes the idea is to incentive as many companies as possible. and to do it fast. If it turns out that in fact someone already had a compound ready to go and got the prize very easily, well that is hardly the end of the world is it?

Depends. What if it would have been produced at the same time and, instead of spending the money on respirators, more people die because you misspent the money.

Don't assume that this money doesn't compete against other uses for it that reduce or mitigate the costs.

I work at Novartis pharma but don't speak for my employer. I also do not work in labs but....

"work from home" does not mean critical things like drug supply or lab work that requires live human interaction is just 'on hold'. It's going on and people are going in where necessary and deploying strategies like teleconferencing rather than live meetings to be smart about risk reduction.

I think the idea of 'reserving' ICU beds for people working on vaccines and treatments is good in spirit but will cause problems. First, how are you going to do it? Let's say today we identify 100 people who are 'working in labs' today in an area and 'reserve' ICU beds for them. What does that mean? Will a hospital with 20 beds have to keep 2 empty 'just in case' one of the 100 needs them? Will they let those beds be filled but kick out a patient if one of the reserved people shows up needing it?

What about people making insulin, flu vaccine, treating other health problems, or even just working at power plants? Just because Covid-19 is our focus doesn't mean these other critical issues go on hold. Likewise labs are not simply scientists looking at test tubes, they have a critical support infrastructure that needs to be maintained as well. I think drawing up a list of 'critical people' to reserve beds for would turn into a fiasco.

Better, IMO, is to draw up local plans to support both those who get sick and support everyone else. For example, in my area of NJ the schools will continue to provide school lunches and bring them to parents that need them. The library is closed but the staff will come in and answer questions by phone or let you take out books (they will bring them to your car). We aren't there yet but I think we could organize volunteers to bring care packages to people under quarantine as well as do some errands for them to make their stay at home easier to bear.

On the national level I think we should explore a national vaccine strategy where we pay for the pre-emptive development of vaccines and possibly even pay people to take them to achieve heard immunity from these new classes of virus (SARS, for example, still lurks out there and could pop up again).

Providing huge prizes for vaccines and drugs for COVID-19 might be helpful but the reality is here vaccines are already being rushed but they take at least a year or more. Think about it, if you had 100 doses of a proposed vaccine today, how could you establish it works? If we dispensed with ethical considerations and took 100 volunteers we would still need, say, two weeks or so to let the vaccine take effect then expose them to the virus then wait two or more weeks to see if they get it. If all this works perfectly the manufacturing process to make millions of doses would still take months more. Right now the problem is not that there's no financial incentive to get to market with a vaccine or treatment that works.

yes I think reserving means you have a clear plan to kick out specific patients if you need a reserved bed. I think you can tell those patients that this is what will happen.

That makes for some pretty atrocious optics. I would suggest that a program of priority for the elite and most-favored should have the PR savvy to at least go hide itself behind a secure perimeter somewhere. Poach the equipment now, before people are watching.

What's that you say? Yes, as I type these words, I realize that this establishment of separate elite facilities is most certainly already being done.

Trump Death Panels?

Imagine a true nightmare - Sarah Palin death panels, all wearing bear costumes.

In the mythical gauze built up around vaccines, many people are completely unaware that they sometimes don't work, or don't work very well, or stop working; and sometimes they actually make things worse. In fact, for example, shedding by the recently vaccinated remains an area of concern, whereby unexpected consequences from rushed-to-market vaccines could be disasterous.

In addition, officials still know very little about the disease itself, incubation, transmission, mutation, natural immunity. They are mainly guessing.

What would they do, after a month of trying, find some compound that seems to work, then rush out 5 billion doses based on that prelimonary success?

Any vaccine in this environment would be a total crap shoot. A desperate hail mary that could just was likely harm its recipients and accelerate the disease as magically stop the disease like a missile hitting an earth-bound asteroid.

And as Gulf War vets can attest, sometimes the prevention is worse than the disease.

In other words, vaccines that pass even cursory standards for safe and effective are a year off. Deal with it. Put the money elsewhere: treatment capacity, increasing health care access, restructring the economy to cope with long term distancing programs and the tsuanami of recession coming; rebuilding government services decimated by decades of GOP deconstruction and the just-in-time/profit-is-the-only metric ideology.

Exactly. This document was clearly written by someone with virtually no understanding of virology/vaccines/public health. If it turns out to be a doctor, I'll put my money on it being an orthopedic surgeon. More likely someone with an academic position in a non-medical field.

Indeed, in the long run a robust vaccine industry and breakthrus in accelerating vaccine development, testing and deployment is very important. It's not a solution for this virus today. We need to think both short term here and develop long term strategies to deal with future viruses.

One long term idea that might yield a huge bang for the buck might simply be investing in some basic protections in 'wet markets' in the developing world. Assuming we can't simply convert them to the supermarket model, it seems like simple things like making gloves, masks, and protective equipment and procedures available to people working in such markets would make it harder for viruses to jump from other species to humans.

Providing huge prizes for vaccines and drugs for COVID-19 might be helpful but the reality is here vaccines are already being rushed but they take at least a year or more.

I don't understand why they absolutely have to "take a year or more."

Think about it, if you had 100 doses of a proposed vaccine today, how could you establish it works? If we dispensed with ethical considerations and took 100 volunteers we would still need, say, two weeks or so to let the vaccine take effect then expose them to the virus then wait two or more weeks to see if they get it.

OK, that's one month.

If all this works perfectly the manufacturing process to make millions of doses would still take months more. Right now the problem is not that there's no financial incentive to get to market with a vaccine or treatment that works.

Is there absolutely no way to cut the manufacturing time with more money? If it took, say 6 months to manufacture 1 million doses, if 10 times the amount of money was spent on manufacturing, couldn't the time to manufacture 1 million doses be cut, say, in half?

Mark, I think the comments above you are a great example of why we need a prize mechanism.

Mark, I think the comments above you are a great example of why we need a prize mechanism.

You're not just preaching to the choir, but to the reverend himself!

https://www.econlib.org/the-answer-one-week/#comment-242406

My “fiscal policy” would include at least two huge (multi-billion-dollar) technology prizes for inexpensive and rapidly deployed testing (e.g.,”$5 billion for the first test that is proven to have x specificity and y sensitivity in 1 million tests”) and rapidly deployed vaccines (e.g., “$5 billion for a vaccine that first meets x protectiveness and less than y percent significant adverse side effects in 1 million people”).

Those comments I made were on March 12th...three days before Tyler even posted this link. ("Great minds think alike" as they say. ;-))

Mark, sorry if I confused you, I meant to indicate agreement with you in my post. Also, if you are the reverend I am the bishop - this is my comment on 24 Feb advocating prizes, note my suggested prize of $10bn and also the idea of a second prize -

https://marginalrevolution.com/marginalrevolution/2020/02/that-was-then-this-is-now-pandemic-response-capabilities.html#blog-comment-160040296

Hi,

In my comments on Econlog on March 12th, I also encouraged economists and others to get together to answer questions like this one:

https://www.econlib.org/the-answer-one-week/#comment-242452

What would it cost to bring the vaccine to market in 2 months? 4 months? 8 months? 12-18 months? If we drew a cost curve and a damage curve (damage over 2 months, 4 months, 8 months, and 12-18 months) my guess is that the two curves would cross at very close to the 2 month mark, indicating that, globally, humanity should be spending much more money right now on developing a vaccine.

For reserving ICUs for people working on vaccines, the most extreme option would be to kick a current patient out, or the less extreme option would be to give them first priority when a vacancy occurs regardless of the criteria normally used to allocate ICUs.

On the social distancing front, grocery stores should ban the use of reusable shopping bags. Local laws, that require stores charge (penalize) customers for using store supplied plastic and paper bags, should be rescinded. Also, cashiers should be sanitizing their hands between each customer. Each of us should be requesting this when out shopping.

If the cashier is washing her hands between each customer what is the problem with a reusable bag?

In reality the virus is somewhat fragile. It is DNA wrapped in a lipid. On a bag, plastic or reusable, it would probably dry out and break apart pretty quickly unless it's protected inside a droplet of water or mucus.

IMO better policy is keep your hands way from your face as long as possible and then wash them before doing your face business. Most cashiers I see now are using gloves so they are probably ok unless customers or cashiers are doing things like sneezing directly on their bags....don't do that.

Plastic bags are much environmentally friendly than the reusable ones anyways, even more so than paper. Maybe we flip 'don't let a crisis go to waste' on it's head and use it for something useful once.

https://www.usatoday.com/story/news/nation/2014/01/06/reusable-grocery-bag-germs/4341739/

Reusable bags are one of those things that's all about the signal and ignores the science. We should all go back to disposable plastic, particularly under the circumstances.

"It is DNA wrapped in a lipid." RNA.

Depending on what it's made of, the reusable might be better. IIRC Covid-19 lasts the longest on steel and plastic (up to 2-3 days).

I think the question is how long can it survive in quantity and quality high enough to infect someone. I'm thinking a normal case here....not one where someone wipes their nose or coughs onto a bag but simply has virus on their hands and touches a bag they are packing.

Sadly, the overwhelming majority of supermarket purchases no longer include the transfer of cash. Credit card purchases don't require either party to touch anything in particular except the product. Maybe that means that a can of tuna or a package of paper towels should be disinfected before entering the home. At the least, this health problem is going to be a big step forward in the adoption of digital currency and the government/bank total control of the medium of exchange.

Just how long it would take for a cashier's hands to get too chapped to handle transactions if using disinfectant between each customer? 5 days? 15?

"Companies shouldn’t worry about getting sued for doing the right thing."

Alrighty, but history shows that many companies will exploit regulatory forbearance to do the wrong thing. So deregulation of this nature should be accompanied by public beheading as punishment for committing crimes under that public trust loophole.

I think we can see looking around us, and even on this page, that people (even seemingly smart people) are really bad at this.

There is a significant risk that something like a million people will die, but that is not the end of the world, it is not a zombie apocalypse.

We can and should just do the prudent things we can in the coming weeks and possibly months to reduce the numbers in that "possible million."

I personally think that throwing around a few billion dollars to save a few million lives is entirely appropriate.

But it doesn't have to be that complicated:

"A physician friend driving home tonight from a long, grueling day at nearly-overwhelmed hospital treating COVID19 patients, knowing it's going to get much worse for us all, saw lines of young people waiting to get in the bars in his city, writes, 'I cannot believe the stupidity.'" - @RodDreher

To quote DT, "SOCIAL DISTANCE!"

Re: "There is a significant risk that something like a million people will die, but that is not the end of the world"

You, your spouse, or your kids or grandparents go first.

I might possibly do that Bill. And yet even so, I diligently social distance and wash my hands to reduce your risk.

Thank you. I do not get closer than an electron to anyone on this site.
And I still wash my hands.

A million deaths sounds overwhelming and dismissing it as "not the end of the world" sounds callous. For context though one needs to keep it in mind that in 2017 there were 2.8 million deaths in the USA. So a million extra deaths is about one third more than usual. And Covid-19 looks like a "normal" disease in that it hits the frail elderly the hardest. Many of them will die this year anyways. So it wouldn't be a million extra deaths. We don't know how many will be extra but if we assume 50% then 2020 is going to see a 15% (or so) spike in deaths. A serious problem, but not the plague.

Disease and death are facts of life. To be sure we should take sensible precautions like washing our hands. But shutting down great swathes of the economy like we are doing is a wild overreaction.

As I wrote it I wonder how many people would not read to the next couple sentences.

Come on, isn't it obvious that I want to reduce it, and recognize that I might be in it?

The #BringBackOurGirls of our time.

This won't be saved by tweets, either the government shuts down the bars or not.

If you have ever been on an airplane when the fasten seatbelt sign goes on, you’re going to be skeptical about the potential for social distancing to succeed.

My mood this morning is that we move to lockdown within two weeks. But at the margin hygiene and distancing still help.

Lockdown already is happening where there is an outbreak. And right now those are nursing homes. China locked down where there was an outbreak. Italy has outbreaks in a few cities. There is little evidence that a lockdown works for prevention. I would bet that it doesn't. The police forces likely would be the spread vectors as they poke around in every corner looking for the guilty and measuring distances between people.

Another thing to consider. Churches are shutting down their services to prevent spread. How many people are going to get ill and die in isolation that otherwise wouldn't because of the automatic social connections and surveilance that happens with regular scheduled social activities? Not necessarily of the virus, but people die every day from lots of things.

Another question. Trump likely has been in contact with more people who have the virus than anyone outside medical circles, yet doesn't have the infection. Why not? Maybe some personal hygiene practices he has. Maybe we don't know the transmission paths very well; maybe there is a huge difference between someone coughing and sneezing and not, someone sitting beside someone in a plane or not, someone sitting for a meal with someone or not. This is important information.

I have been watching my interactions with people over the last week. I'm very seldom closer than a yard to anyone, and it isn't hard to maintain that. That is very different from a hockey game where you have 20,000 people screaming and yelling packed like sardines.

There is no 100% in any of this, and any attempt to get close to that will create it's own dynamics that likely will be counterproductive. Look at the crowds in airports last night.

Imagine giving an order for a city that no gathering of more than 15 people, including workplaces, with exceptions for medical provision. By 8am tomorrow morning. At 7:30 every building will be crowded with everyone getting their work to do at home, stuff they need for whatever. Is that what happened in Italy? Have what they done worked?

Increasing the likelihood of transmission than a reasonable edict on size of gatherings, lots of work with people on practices and protocols for providing services. Make sure there is lots of everything everwhere so people don't rush around to gather in crowds to get necessities. Maybe something simple as shutting down the lunchroom in workplaces.

I'd like to see the numbers on choking deaths. If it happens in a public place likely someone will do a Heimlich and save you. In private you are dead. In the US there were over 5000 of those in 2018.

Remember with this that there are no good decisions, only bad ones. It is very very easy to make things worse. Anything that makes it better is extremely difficult, costly and tenuous.

I keep seeing Americans chattering about "lockdown". What precisely is it?

A pipe dream that somehow an edict will control the movements and activities of over 300 million people.

How could you not know?

There are ranges in meaning, from the French closing non-critical businesses, to the Chinese welding shut apartment buildings.

If you have ever been on an airplane when the fasten seatbelt sign goes on, you’re going to be skeptical about the potential for social distancing to succeed.

Not when I have on my trusty Darth Vader respirator and Star Wars Stormtrooper uniform! ;-)

It would be *very* interesting to do some sort of experiment with an innocuous virus in a real airplane to see whether if *everyone* wore an N95 face mask and gloves, whether transmission of the innocuous virus would be reduced on a typical airplane flight.

It would probably take longer than the life expectancy of any researcher to get such a study by an ethics review board, though. So perhaps some sort of computer simulation could be done.

Remember that in France they didn't social distance soon enough or well enough, so they got lockdown, and then people reacted to lockdown by taking to the streets in mass demonstrations.

You can't make this stuff up.

Low trust society in action

Maybe you should think back about all you've done to raise trust in our society.

Are alternatively all the positive messages you've decided to shit on.

You spent literally five years on this blog claiming the entirety of the Executive Branch and Judicial Branch of the United States Government were literal KGB intelligence assets acting in a coup to overthrow democracy in the US.

I assume you've been amplifying these Alex Jones QAnon level batshit insane conspiracy theories for the last five years on other blogs, Facebook, Twitter, Reddit, Tumblr, 4chan, and news comments.

Projection for a Boomer indicates a lifetime of lack of self awareness.

No I didn't.

And it is amazing that you cannot recognize what your rants actually show.

Your comments:

I think there might be a mistake here. It is that if Trump were in any way compromised Putin would want to hide that. That Putin wouild want Trump to hide it.

The strongest counter to that is it the destruction of NATO undermines the strength and security of the United States, and improves the Russian ability to influence peripheral states.

“Trump...If true, this would be a sell-out of Ukraine and a monumental victory for Putin”

So, can we really paint this as Trump just being "foolish" again? Or who's line is he toeing when he dutifully says that the people of tiny Montenegro are so, so dangerous? This guy has to be compromised. There is just no way anyone, even an innocent fool, blindly follows along to "the great threat of Montenegro."

There really was no precedent for that yielding of national sovereignty to foreign interference. And certainly since Trump got his full briefing on that intervention in January 2017 he has been trying to reset expectations that this is normal.

A bombshell New York Times report published Tuesday revealed that in a February conversation in the Oval Office, Trump asked Comey about jailing reporters who leaked classified information.

To be honest I remembered my own surprise and concern at Trump's attacks on a free press and went looking for an example. This seems very different to me than any time in the last 50 years. A president who wanted to jail reporters seemed relevant.

Josh, we have old news that Russians did everything from attack voting machines to generate Facebook memes for the last election. We have an intercept of Putin instructing his intelligence services to do these things for Trump. We have both public (from the podium) and now private (in these emails) acknowledgement of these efforts from the Trump campaign.

That’s from two posts. TWO, lmao.

Remember, or are you having a Joe Biden moment ( hopefully minus the sexual assault of children)?

Your Alex Jonesesque QAnon dementia addled Boomerism?

That just demonstrates your inability/insanity.

You treat "if Trump were in any way compromised" as the same as "literal KGB intelligence assets."

Is English your second language, or are you just nuts?

That’s not exactly fair. You’ve been leading the charge of negative nellies at MR since 2016. Every POTUS tweet and story has been linked here to the point the comment section has become an aggregation site for all things Trump all the time. And don’t bother responding with a “I was warning you POTUS was incompetent all along” speech. It was the constant fear mongering that lead people to believe (and continue to do so) that a pandemic was no big deal. Had half the political class and punditry at least attempted to behave like adults over the past 3 years the man-child in the Oval Office wouldn’t have to act like it’s a conspiracy against him.

Tortured pretzel logic.

And frankly you and Skeptical should hide your heads and shame that you would even want to take this conversation in that direction when I am offering positive and helpful advice on the pandemic.

China was so low trust they used the full force of a totalitarian government to ensure total obedience of everyone to all government decrees.

Most people in free societies are not willing to trade their future freedom for the sort of safety the Chinese state was seemingly able to create by using its centralized power.

I'm pretty sure that all free societies also have things like emergency powers and martial law.

It is an idiocy of our complacent age that they are never needed.

And that is generally how free societies become non-free ones, though the use of emergency powers and martial law.

Not really. The US has had emergencies and taken emergency actions time and again.

https://www.nationalww2museum.org/students-teachers/student-resources/research-starters/take-closer-look-ration-books

We incarcerated Japanese-Americans for world war II, and then just said "oops, our bad."

Yes, and sometimes we'll get it wrong, per your example. If we knew what to do it wouldn't be a crisis.

I don't think so. First we don't have that many examples of not-free societies becoming free. For example, Germany was barely a functioning democracy for very long before the Nazis came to power. Russia was "free" for maybe 45 minutes between czarism and communism.

Second, there's plenty of times free nations have used emergency powers in crises's without it destroying the underlying freedom. Riots, natural disasters, and wars do happen and a government has to be able to respond.

I think the more critical component is weak underlying institutions that support freedom and fake emergencies used to maintain power.

The cops grabbed a fellow at a company I once worked for and hauled him away. Turned out he had failed a test for TB.

Prior your autism is showing again. Grab that weighted blanket for a second.

Mainland Communist Party China is a low trust society. That’s why they had to use the military to shut Wuhan down, and people still escaped with no regard for others.

High trust society would be Taiwan. No need to call in the military. Am I a risk? Then I quarantine. Social cohesion works. I’ve spent a lot of time in Taiwan with family. No trash on the streets, no homeless, no crime, no junkies defecating in the street. 12 year old girls can ride the subway late at night alone in a city of millions with perfect safety.

You people are no Taiwanese. You’re no South Korea. You’re not even mainland China.

You tweet #FlattentheCurve and then go to an out of town wedding like anonymous here.

I’m quarantining as directed since I’m not a jackass, but I’m preparing to take the family and work from home in *Taipei until the garbage low trust countries are over the pandemic.

*Depending on internet speed and risk of infecting grandparents, potentially Singapore instead of Taipei. We have a large office there.

No need to make up how the French act.

Another good example followed a French headscarf ban. Osama and Co. tried to get French Muslims riled up by such blatant hostility to Islam. So what did French Muslim head scarf supporters do? Protest en masse against a foreigner Osama having the gall to think he could get involved in what was clearly a discussion involving the French.

Or a much more recent example is how the French made the Russian attempt at interfering in a French election enjoyably laughable, showing just how stupid the Russians were to attempt to jerk the French around.

Quite a pronouncement! I'm sure you have the data at hand on the means of transmission.

What defines the populations where it is spreading? Is there a definition? If so a lockdown may not work because it might exempt by necessity the people and activities who are spreading it.

We need a lockdown! We have hospitals who have failed and become centers of disease promulgation by both bad practices and terrible protocols. The medical professionals are mostly infected, all the sick people are ill and everyone who has gone to these places in the last week has been exposed and likely spreading it. We need everyone, including the onion farmers in Breton to stop what they are doing, stay home and keep away from everyone.

Makes perfect sense.

I have no idea who you are responding to. I know I have not called for a lockdown today. I've just shared my expectation that we will get one.

There are enough people out there excusing what they do, or even relishing it, that we do risk this blowing up as big as Italy.

https://twitter.com/ATabarrok/status/1239192915462807554?s=19

And so? Any 'solution' in a situation like this that requires almost total compliance will fail. By definition.

What is the naysayer argument at this point, that we shouldn't even say "let's all pull together" because people won't pull together and we're all doomed?

If I was out saying that today I would really examine who I was.

I must say that was a silly comment. What does 'lets all pull together' mean? I thought we were supposed to self isolate.

This is a hard problem. If I self isolate I could be responsible, personally responsible for creating a panic situation that creates a run on food products. And if the brilliance of the media environment is to be counted on, it would go viral, be the top of the news, and spread worldwide like the toilet paper nonsense in Australia, and cause serious disruption.

So some hairy fairy nonsense, and wondering about what type of person would consider these things is pure garbage, and you are smart enough to know better. You should be ashamed of yourself.

I figure I have about a 30% chance of getting it, and probably a 65% chance of surviving it if it turns into a full blown epidemic where I live. I work in what was described by one of my customers this week as critical infrastructure to provide essential services to Canadians. Usually their communications are telling me the opposite, so I suppose I should be gratified.

I've said this many times and I'll repeat it. There are no good decisions, there are only bad decisions and ones that aren't bad decisions. It is about minimizing harm. The lady at the press conference yesterday was talking about the possibly bad consequences of getting a negative on a test, showing that there is no unalloyed good here. And I'll repeat this again as well. Any proposal that will have a deep effect on people's lives for more than a week has to take into consideration a 30% at least non-compliance rate.

I hate to stop on your first thought, but self-isolating is very much an part of pulling together.

And maybe it really is a very safe partisan divide.

@NBCNews/@WSJ poll finding: 61% of Democrats but just 30% of Republicans say they've "stopped or plan to stop attending large public gatherings"

The French are the ones who prattle on about "social solidarity" and "fraternity" (equality, liberty, fraternity) and castigate Anglo-American individualism. Yet when the time comes, they resort to the Ancien Régime.

How about a $10 billion prize to the company that stockpiles a thirty year supply of medical supplies and equipment. And $1.5 trillion in loans to the companies that quadruple our hospital bed capacity?

The ICU priority recommendation ought to be DOA. We already know the politicians, celebrities, and the wealthy have reserved those spots. Besides where do you draw the line? Lab scientists need a janitor, dependible elecricity to the facility, an internet connection, daycare for their kids, a place to buy gas for their cars, etc

Don't forget to throw more money at the banks. That was barely touched on in the proposal, but is the only official response that is assured.

I think we could simply buy masks and other supplies for less than $10B. Unfortunately these things have an expiration date so you can't simply buy '30 year worth' and store them in warehouses just in case.

3M said that after the SARS and H1N1 outbreaks, they decided to build a surge capacity for masks so they could double their production if needed. They are doing that now, of course, but clearly it isn't enough.

I think a few options are:
* Surge hospital capacity. Pay hospitals a premium to keep a surplus of supplies onhand.
* Surge conversion. Take a census of less essential medical service centers...for example plastic surgery centers, and provide that they will be repurposed in the event of an emergency
* Surge training. As Stalin observed, quantity has a quality of its own. If there's a sudden ten or hundred fold need for respirators, we can have simple machines that people can be trained to operate quickly to use. This won't be as good as specialists but it can be better than simply rationing the normal capacity. At home there are already a lot of medical procedures people do themselves or by caregivers after being trained by nurses.

Obviously $10 bn is a lot of supplies. But my point remains, I was merely using the author's numbers.

The problem with all this surge capacity stuff is it is the opposite of how we structured our economy. And in the end, the surge incentives are in fact an argument for more market-altering corporate socialism, although no one can quite bring thesmelves to use the S word yet. Paying private hospitals a premium to be ready to provide a public good is an argument for creating pubic hospitals. Although we all know that's icky.

But yes, China showed what can be done to set up temporary capacity in short order. But we aren't China. And the difference isn't red tape. The difference is in how we are structured from top to bottom, and that includes profiteers and other self-interested sociopaths who come out of the woodwork during a crisis.

As for simplicity. That too is the opposite of how we structure things here. Where is the layers of profit and arbitrage in a simple ventilator that can be operated by a modestly trained layperson? FFS, this country hasn't even really truly rolled out AEDs yet, despite being an absolute game-changer in dealing with heart attacks.

There is a simple, easy to use, cheap to mass produce ventilator out there waiting to be built, which while not perfect, could add massive capacity increases in short order. But we will not be the nation to invent it. However, we will steal it, add a bunch of gee-gaws to it, and triple the price.

I'm not sure socialism is really the right word here. I'm a bit old school and IMO socialism means mass government ownership of the means of production. It does not mean gov't policies or deviations from a pure free market ideology. In other words, government deciding it will run the coal mines-> socialism. Government giving people grants to heat their homes in winter -> Not socialism. It also means government involved in *some* production isn't really socialism either. When we talk about how an economy is structured, we are talking in generalities and minor exceptions to the rule don't really count.

So let's take note about hospitals, doctors and nurses. All these are protected by special government license. Part of this guild protection, which goes back centuries in law and custom, has always been a public service component. Doctors and nurses all know that in an emergency they may be called upon whereas, say, dog groomers are not.

That means hospitals already do have some measure of 'surge capacity' built into them by this public requirement that, say, private surgical suites do not. We simply may need more going forward. This is less a new policy than simply reassessing old ones.

I don't necessarily disagree with what you're saying. But I think two factors are important here.

(1) Over the last forty years or so, we took these guild-protected quasi-public services and let them turn into rent-seeking parasites, while largely removing much of the legal and unwritten social obligation side of the deal.

(2) We are given an opportunity as a polity from time to time to hit reset (i.e. 9/11, 2008 crisis), but instead we throw more money and yet more rent-seeking at the structure, in effect doubling down. Every crisis becomes an argument for yet more corporate subsidy and yet more deregulation of the social obligation part of the deal.

As far as health care workers showing up in a crisis, that is mainly because human beings in the labor component have not adjusted their loyalty to the system to match the loyalty the system gives them. People are saps, and caregivers are the worst. Just get to know a teacher. The day of reckoning will be the day health care workers stage a mutiny, working without masks or ventilators in an epidemic, they are going to walk off, and tell the hospital CEO and its PE funders to sell their vacation homes and buy some damn masks.

Seems like a lot of the people need a place to be cared for, and isolated, but not real emergency services. Hotels are typically underused at this point, so if there were some built to a higher standard that could convert to a medical type facility, I'd think that it would be a useful place to put some of our preparedness dollars.

Indeed, isolation and light care can be handled with hotels, even RVs and tents.

But its lack of ICU capacity that has the officials scared

First, here's a link of treatments that are showing promise: https://www.pharmacytimes.com/news/potential-pipeline-medications-for-the-coronavirus

Chloroquine/hydroxychloroquine is particularly exciting. These are being tested now in humans. The difficulty is in doing proper human trials, on the fly, with so many confounding factors. That said, it appears in many countries they're going ahead and using some of these drugs in severe COVID-19 cases, so we may not have long to wait for meaningful data. However, the document's admonition to begin "large-scale screening project for all existing drugs" is silly beyond description. If we gave one existing drug to a single infected patient, we'd run out of patients before we'd run out of drugs. The writer of this document is obviously naive to pharmacology, medicine, drug development, and common sense.

On vaccines, aside from the long lead time, there are other issues that this document naively ignores. Do you give a prize for a vaccine that are like the typical flu vaccine (30-60% effective)? Do you give a prize if it turns out the immune response to any COVID-19 vaccine is transient, and it turns out a truly effective vaccine isn't viable. Do you give a prize for a vaccine that shows up in 18 months after several medications have been shown to be highly effective for preventing the development of severe cases? For a variety of reasons, a vaccine may be only a small part of the puzzle, but this document treats it like a magic bullet.

The document recommends temperature checks in all commercial establishments. We already know this misses most active-but-ambulatory cases, given that the viral shedding is happening for days before symptoms show up, and many people don't show symptoms while being actively infected. Wasting time/resources of this is akin to the "security theater" that goes on in airports now. And the mandating of record keeping for the temp checks!?! I can't think of a better way to spread the infection than to have people being forced into a nodal point of every commercial establishment to record their information and share their germs.

As for sharing information among labs and doctors, I was reading on a virologist's twitter yesterday that there are more papers on COVID-19 being submitted for publication than can be peer reviewed for publication. I've already seen cases on medical forums of misinformation and completely speculative information being passed around among doctors. There is more information coming out than can be digested and analysed, at the same time that most treating physicians are overwhelmed and don't have the time to treat their patients as experimental subjects. By that I mean that in a clinical experiment, there is a massive amount of documentation. Someone needs to get patient consent for data collection, then collect patient data on a regular basis (i.e., go to each hospital and doctors office and read medical charts) and then enter it into a database. In this crisis, doctors and nurses simply don't have the time, and no such central database exists.

As for childcare, yeah, that's a massive problem. And any childcare solution you come up with for the millions of health care professionals and researchers and public health professionals will likely be solutions that are in the opposite direction of social distancing. And you also need child care for the people who work in the plants that create medical supplies/reagents/etc., and for the people who transport those vital materials. Oh, and the people who are keeping us fed. And the people who are keeping the water running, and the toilets flushing, and the lights on and ventilators running.

The truth is that the world is responding to this virus in a way that is unprecedented. Despite the missteps in China in early days, and in the US and many other countries up to the present, information is being shared and treatments are being sought and the public is steadily getting the message. The message about social distancing is out there, and people are responding. Still way too much misinformation and confusion and double talk from politicians, but it could be, and has been, much much worse.

Excellent post #1 as well

I think we should note that peer reviewed papers and clinical trials are not the only sources of medical knowledge. As doctors and nurses treat patients, they collect observations and share best practices. Doctors will try treatments and word is shared about what works and what doesn't. For example, I've seen reports that some patients are being treated with tamiflu.

The papers and trials come later to refine that knowledge. For example, if a drug seems to work sometimes in a field, the data can figure out when it works best, with what type of patient and at what stage of the disease and when will it not help. There's a lot that goes into medical care beyond just prescribing a magic drug that 'works'.

Yes, medical professionals definitely share info. As I alluded to, though, sometimes anecdotal clinical impressions are misleading, and the history of medicine is full of examples where doctors were slow to respond to empirical evidence that contradicted their incorrect assumptions and their own gut feelings. And slow to recognize when they are doing things that are counter productive (like not hand washing between patients, for gawds sake!). For example, I've seen in a couple of doctors-only forums that people were repeating what the French health minister recently alluded to, that ibuprofen use is a risk factor in COVID-19. I don't think there's any credible evidence that this is true, but health care professionals have been among those sharing this idea.

I agree, an analogy might be diamond mining. Sometimes you luck out and get a 'diamond in the rough' but most of the time you have to churn through tons of dirt and even then the diamond has to be polished and cut by an expert before you get the true thing.

The controlled studies, peer reviewed papers are the end product of that refinement. Under that is a lot of knowledge generation churning that quite often is unhelpful but does generate knowledge (and until relatively recently was the only way the field generated knowledge).

Comment is 3 sigma above the MR mean.

Responded in ways that are unprecedented...

For example, shutting huge swaths of the economy literally overnight, in the face of a threat that is at this point largely anticipatory. (Not saying it isn't real, saying its not tangible yet)

Do you give a prize for a vaccine that shows up in 18 months after several medications have been shown to be highly effective for preventing the development of severe cases?

My recommendation would be a technology prize that declines over time, and declines dependent upon:

a) effectiveness (against the current strains...even if subsequent mutations render the vaccine against the current strains ineffective on the later mutated strains), and

b) side effects.

So a prize might be presented as a set of curves, with amount of prize on the y axis, and time to develop and deploy 1 million vaccine doses on the x axis. Then different curves for levels of effectiveness and side effects.

With regards to testing, the following company is a market leader in molecular diagnostics. More than 23k locations have their system. It looks like they will have an accurate point-of-care test available very soon.

http://www.cepheid.com/coronavirus

The US government should get all of our major manufacturers -- GE, Lockheed Martin, Apple, Honeywell -- and tell them "I need 1 million ventilators by the end of the month."

We converted many of our factories in WW2. We're much more sophisticated today. Why isn't this happening?

Because there is no magic way to train the people to man those ventilators 24 hours a day as they roll off the assembly line?

Well nurses, hospital workers even volunteers could be given crash course basic training and put into the field if need be. China is sending people and equipment to Italy to help. If the virus peaks at different times in different nations their surplus capacity could be lent out to nations that are suffering shortages.

However, that staff needs to be infection free, 24 hours a day. That is, they need PPE, and every time one tests sick, they need to be replaced right then.

Staffing is not a trivial problem with an extra 10,000 ventilators, much less a million.

You might look at the Defense Production Act which gives the president the authority to require companies to produce items for national defense.

We couldn't convert factories that quickly back then, either.

Tooling up for every part takes months itself. Then you need to make sure they all can work.

Its not impossible, maybe they can make 80% quality ones...quick and dirty. I'd say #1 worry would be...do I get sued after the crisis is over by family members?

Government does Manhattan Project.
BIll Gates does the Prize.
Free Market does profit driven.
Universities (supported by NIH) do Let A Thousand Flowers Bloom.

All of the above. If anybody wins, we do.

How are the Universities, these bastions of diversity, doing on the “thousand flowers blooming” thing?

Okay, I was "why is no one doing anything about this" for a long time, but thinking that research is going to stop because scientists don't go to labs is definitely overreacting. If this is going to happen the US truely stupid and stocking up on toilet paper is justified because supermarkets are going to close.
Even in China essential stuff obviously kept going. If the US overreacts and commits suicide by panick then your political system has truely failed.

Four more years! Four more years! Keep American great!

Donald, is that you?

Prizes do not work! Stop advertising this nonsense!

I've thought for some time that we need a real and rational civil defense budget. There are a lot of things we could and should do that fall into the general categories of "more robust than economically optimum" and "things we do just in case really bad stuff happens". We should do a risk assessment, and set a budget (say 5% of the defense budget.)

And there are real risks much worse than the Wuhan flu. Grid failure due to natural or intentional EMP is high on the list. Many of the components for grid repair have a year or more lead time - when the grid is up. A really major earthquake.

This could include establishing stockpiles, supporting otherwise uneconomic infrsatructure robustness, maintaining professional and volunteer organization capability and trained people, identification of risks and systematic work to reduce them and mitigate impact in the event.

There is already a Strategic Petroleum Reserve. There is a strategic medical supply reserve (albeit perhaps not large enough). We should subsidize utilities to stockpile grid repair materials, and increase grid robustness.

Clearly we should ensure that critical manufacturing capability, including drugs, is maintained in the US. Encourage medical auxiliary organizations that could provide surge capacity.

Of course, this is ready make for graft and abuse. One of the problem New Orleans had in Katrina is that the local levee district spent their money on other things than levees. This could be that that time a million. Build in an aggressive and independent inspector general.

Much of our national political capital is wasted on political correct BS, e.g. what amount to micro-imperfections. That energy and attention should go here.

+1, but I'd add to not just have our medical resources produced here, but in a variety of places. If the US' capacity is out because of a natural disaster, I'd like product flowing in from overseas. After the east coast power outage we all had to make sure our data centers weren't on the same grid.

All this, but multiply figures by 10 or 50. What is more important right now?

Missing simple stuff which I’ll add myself here:
Clean and disinfect cash
Rollout ways of doing sales transactions that don’t require touching a pad or swiping
Get rid of self serve gas
Work cohorts at minimum wage places: one set of employees work together on the same days, less mixing staff and interactions.
Shopping allowed for each person once per week, everybody is issued a shopping date by perhaps the state dmv and merchants enforce by checking drivers license. This will both slow spread and help with rationing.

All relatively low cost and all would dramatically flatten the curve. If we’re going to do these we should do them sooner not later. But we’ll wait until too late because we don’t optimize for effective political leadership.

Not saying we don't need to do things but part of the suggestion comes across as "lets throw a lot of money at the problem and hope something good happens". It's possible that will occur but not clear to me that this problem is that different from other problems where that approach has failed badly.

LW had a very good thread about how to actually identify the good expert from the paper tiger experts. That is clearly one of the problems here and the author seems to assume that is not a problem.

DRAKO anyone?

Why do children seem to fare so much better than adults here? Could that be related to the ratio of "smart" t-cells versus the mature t-cells that just fight the invading cells/virus they were programmed for? If so, how to shift that ratio towards the smart t-cells (meaning the non-specify, learning/adaptive cells). That would seem to offer benefits well outside what getting a vaccine for some narrow set of viruses.

Why do children seem to fare so much better than adults here?

Immuno senescence. We need to reverse immuno senescence. This is the ONLY option that can work.

Here is one method of doing so. I actually know the guy (Greg Fahy)
who did this: https://www.tellerreport.com/life/2019-07-12---rejuvenation--researchers-want-to-have-defeated-aging-.Bkgc43H8bB.html

One of the reason why this kind of bio-medicine has taken so long to be developed is because of f**king ideology. There seems to be an ideological bias against truly restoring bodily homeostasis.

"Why do children seem to fare so much better than adults?" No idea.

Why do Italians fare so much worse than many other nations? Dunno. (Don't even know if they do.)

When they referred to it as a novel coronavirus that made the point. It's new therefore we don't know much about its behaviour.

The Italians are faring the same way the rest of Europe is faring, except they are getting there sooner. The only difference is they got more cases earlier than the rest of Europe. Look at this site and you'll see that the rest of Europe is on the same trajectory, except Spain, which is on an accelerated trajectory. http://nrg.cs.ucl.ac.uk/mjh/covid19/

After my comments above, I've been thinking more about this, and have some suggestions for the document.

(1) Perhaps the number one thing that could be done in the very short run that would save lives and mitigate this pandemic is a radical and real-time sharing of information across borders and among the key physicians and medical directors at the hospitals treating severe COVID-19 cases. I'm talking about some kind of private cross-borders forum, doctor-to-doctor, where the specifics of what they tried, the profiles of their patients, and the patient responses, could be presented to each other the way doctors do at a grand rounds. There is currently no mechanism for this, and to the extent that it happens it is because one doc happens to be a friend to another doc at a different hospital. In China and South Korea in particular there have been patients treated out of desperation with off-label meds (like chloroquine) and meds still in clinical testing (like Remdesivir). There have also been real time experiments with different regimens of corticosteroids, NSAIDs, and who knows what else. Most of this will never be published, and that that is published will be revealed piecemeal and weeks/months from now.

If there was a place where these physicians with COVID-19 experience could share their real-world experiences, without having to go through the usual process of preparing a paper for formal publication or going through official channels, lives would be saved. Right now every country has privacy laws and liability considerations and strict restrictions on sharing medical information, even anonymized medical information. Plus many nations governments don't trust each other, and are actually floating conspiracy theories about the origins of the pandemic. Who would start this up? Who would be allowed to join? Would people actually admit to blatant failures? There are a lot of barriers to doing this, barriers that only national governments and national health ministries could overcome. Given most government leaders have been clownish on the matter, and the WHO and most national health ministries are still putting out misinformation, I'm not optimistic. But this would cost little, it would require minimal bureaucracy, and yield real dividends within days. Forget the vaccine, this is the low-hanging clinical fruit.

(2) The document also emphasizes "social distancing," which the world is abuzz with now. And yet no one seems to quite know what it is. This document certainly doesn't. Just yelling "social distancing" and cancelling large gatherings is underwhelming, and mostly symbolic. I see health experts and national health ministries saying things like "keep an arm's distance away from others" and "cough into your elbow" and "don't shake hands." Will that keep you safe? No. It will help, but it's grossly inadequate.

There's also the misinformation that people aren't contagious unless they have symptoms, and the partial misinformation that the disease is spread by coughing and sneezing. Yes, coughing and sneezing is one way it's spread, but I'm not even sure it's the dominant way it's spread.

What's missing? An emphasis on contaminated surfaces. I suspect that much if not most of the spread of the virus is being done by people touching contaminated surfaces. Infected people without symptoms (who are clearly infectious, the WHO be damned), or mild symptoms, touch their face/mouth/nose, picking up viral particles which they then deposit on every surface they touch. The virus is viable for days on those surfaces, waiting patiently. Social distancing won't change that.

People touch their faces constantly, and then touch their keys, their phone, and everything else in reach. You can wash your hands every time your near a sink, but it won't do much good unless you avoid touching both your face and any surface you can avoid touching. You can go to a grocery store when it's practically empty (social distancing!) and still end up figuratively shanking hands with a thousand people who were shopping there ahead of you. Yet somehow very few people are pointing out that this virus is easily spread by people with minimal symptoms to innumerable surfaces, that the virus can live for days on those surfaces, and that a casual touch of a contaminated surface followed by a casual touch of one's face is all it takes to be infected.

Like the first suggestion, explaining respiratory viral spread as going beyond avoiding coughing/sneezing is low-hanging fruit, costs little, and can be implemented immediately. The emphasis on hand washing is great, but it being presented out of context and incompletely, so people don't understand.

Great minds think alike. I was just going to comment on the subject you raised in item 1 under the category of how private property rights might impair sharing and disclosure, and how one could devise a system where companies that shared information which led to a discovery could be compensated for such sharing. One model is a patent pool, or a pool where members would have rights to use or derivative rights based on their contribution to the pool. An outside arbiter after the fact would allocate property rights and value contributions to the effort.

So, for example, one drug company is hung up on a problem, their staff does not have the skill to solve it, and would benefit from talking to another drug company to draw on their expertise to solve. Today, you wouldn't see that. But, through a consortium rights model you might.

We've done things like this in the past in the high tech space: See Antitrust Research and Development Act of 1984. This, along with powers under the Defense Production Act could clear the way for collaboration that might, because of problems involving antitrust or ownership of property, be standing in the way of collaboration on R&D you would want to see.

I was responding to Kevin's comment immediately above.

Also, this approach would not require a prize other than sharing in the result of the collaborative effort.

Yes, this is the kind of collaboration that could yield big results, and has been done before in extraordinary situations. This is certainly one of those.

Tyler, I expect my prize if any drug company and the government goes forward with this idea and it leads to the quick development of the drug.

I just won't know how to spend it.

How selfish of me. I'll share the prize with Kevin.

Commandeer vacant Sears stores for testing, triage, low-acuity care, whatever.

Why aren't they encouraging people (especially old people) to get flu shots, now? It seems like that could free up some of the capacity already in the system.

Segment the population into two groups - younger cohort and older cohort.

The mortality rate of children seems to be low and they can be exposed first in an effort to develop an overall population herd immunity. Those non-senior adults who interact with children would be included in this group. Younger adults would also be included in this group so that the normal economy would remain in some form. Schools would remain open.

The older group would be strongly advised to quarantine itself (not on an individual level, but within its own group which may end up being quarantines on an individual basis) from the younger group until that younger group has developed its own in-group herd immunity. Nursing homes would strictly restrict visitations (especially to those belonging to the younger group).

People would register which group they belonged to, with maybe an age threshold (maybe like 45) providing a default assignment. If someone in the older group is found to have interacted with the younger group or entered a place where the younger group is permitted (like schools), that person becomes a member of the younger group.

So I was ahead of the curve on this one.
From the Surgeon General of the US.
Hospital & healthcare systems, PLEASE CONSIDER STOPPING ELECTIVE PROCEDURES until we can #FlattenTheCurve! 👇🏽

Each elective surgery you do:

1) Brings possible #Coronavirus to your facilities
2) Pulls from PPE stores
3) Taxes personnel who may be needed for #COVIDー19 response

A Harvard epidemiologist professor's POV about England's strategy to fight the COVID-19.

"Your house is on fire, and the people whom you have trusted with your care are not trying to put it out. Even though they knew it was coming, and could see what happened to the neighbours as they were overwhelmed with terrifying speed, the UK government has inexplicably chosen to encourage the flames, in the misguided notion that somehow they will be able to control them."

https://www.theguardian.com/commentisfree/2020/mar/15/epidemiologist-britain-herd-immunity-coronavirus-covid-19

They'll blame the National Health Service, when it can't handle the load, for Boris's complacency.

The strategy was published in 2011. The shrewd amongst this readership will notice that that is eight years before Boris became PM.

How do you measure the first to market when the government determines the time to market? Is it fair to make the reward based on who can get through the regulatory regime first, and will this cause gaming the system to benefit a body.

Today the government announced that the first vaccine will begin tests on Monday: https://apnews.com/8089a3d0ec8f9fde971bddd7b3aa2ba1

Given the fact many people will be asymptomatic and or have mild symptoms/case and never even know they had it - wouldn't it be wisest to have a test for those who're now also immune to it because they've already experienced it? I personally believe this has been around for months and those of us who were quite ill back in January and February are now in fact immune to it. Not only was it extremely contagious everyone I have spoken with that became so very sick is describing the exact symptoms now associated to this specific virus. We all assumed it was just a really-really bad cold or the flu. If true a lot of this fear could certainly be toned down.

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