Month: April 2020
Want to know how many tuberculosis cases there were in the U.S. last year? Ask the CDC. Want to know about health-care-associated infections? Ask the CDC. It knows.
But ask how many Covid-19 tests have been done, and the CDC’s doesn’t have an answer. Want a daily update on how many people are getting hospitalized for Covid-19? The CDC isn’t tracking it. Want to know if social distancing is making a difference? The CDC doesn’t know.
During this pandemic, when accurate, timely, nationwide information is the lifeblood of our response, the CDC has largely disappeared.
The performance of the world’s leading public health agency has been surprising, and by that I mean surprisingly disappointing. When the outbreak began, the CDC decided to forgo using the World Health Organization’s testing kit for Covid-19 and build its own. The test it shipped out to states was faulty, creating problems that stretched for weeks and slowed response as states waited for replacement tests.
Here is more from Ashish K. Jha. As I’ve said before, our regulatory state has been failing us.
Matthew Bonds, who is at Harvard, wrote this response to my original post on epidemiologists. I am offering it in its entirety, click here.
Here is the first paragraph:
Since the novel coronavirus outbreak turned into a global health and economic crisis, one of the few silver linings has been unprecedented collaboration across spheres of science, innovation, and policy that have potential for long-term benefits. My training is in economics (PhD) and ecology (PhD) with a specialty in infectious disease modeling. Over the past decade, I have focused on implementing global health delivery programs where the lack of models and technical solutions are rarely the biggest problem – instead, the challenge often lies with breakdowns in the systems of delivering those solutions. That is not the case with COVID-19. We do not have solutions at our fingertips. We do not know the full scope of the problem, and consequently how to best navigate policy tradeoffs. So, I was dismayed to read, “What does this economist think of epidemiologists?” by Tyler Cowen, which struck me as a reinforcement (maybe even a celebration?) of boundaries that do more harm than good.
Do read the whole thing, and note that Bonds wrote his economics dissertation with Dwight Lee (a former co-author of mine) at the University of Georgia. Here is the home page of Matthew Bonds.
4. Words from Holman Jenkins (WSJ): “Please, if you are a journalist reporting on these matters and can’t understand “flatten the curve” as a multivariate proposition, leave the profession. You are what economists call a “negative marginal product” employee. Your nonparticipation would add value. Your participation subtracts it.”
MRU introduces a new series, Economists in the Wild. In this series, we talk with economists in widely varying fields about their cutting edge research. First up in the series is David Autor on the rise of superstar firms and the fall of the labor share.
More great material for your online economics seminars and a great resource to use with Modern Principles!
Here is the opening:
Here is the full story by Will Hobson. Recommended.
That is the topic of my latest Bloomberg column, here is one bit:
Some of the safer locales may decide to open up, perhaps with visitor quotas. Many tourists will rush there, either occasioning a counterreaction — that is, reducing the destination’s appeal — or filling the quota very rapidly. Then everyone will resume their search for the next open spot, whether it’s Nova Scotia or Iceland. Tourists will compete for status by asking, “Did you get in before the door shut?”
Some countries might allow visitors to only their more distant (and less desirable?) locales, enforcing movements with electronic monitoring. Central Australia, anyone? I’ve always wanted to see the northwest coast of New Zealand’s South Island.
Some of the world’s poorer countries might pursue a “herd immunity” strategy, not intentionally, but because their public health institutions are too weak to mount an effective response to Covid-19. A year and a half from now, some of those countries likely will be open to tourism. They won’t be able to prove they are safe, but they might be fine nonetheless. They will attract the kind of risk-seeking tourist who, pre-Covid 19, might have gone to Mali or the more exotic parts of India.
laces reachable by direct flights will be increasingly attractive. A smaller aviation sector will make connecting flights more logistically difficult, and passengers will appreciate the certainty that comes from knowing they are approved to enter the country of their final destination and don’t have to worry about transfers, delays or cancellations. That will favor London, Paris, Toronto, Rome and other well-connected cities with lots to see and do. More people will want to visit a single locale and not worry about catching the train to the next city. Or they might prefer a driving tour. How about flying to Paris and then a car trip to the famous cathedrals and towns of Normandy?
Maybe. But I might start by giving Parkersburg, West Virginia, a try.
Mitch Daniels, the President of Purdue, has outlined a preliminary plan to reopen involving test, trace and supported isolation on campus.
We intend to know as much as possible about the viral health status of our community. This could include pre-testing of students and staff before arrival in August, for both infection and post-infection immunity through antibodies. It will include a robust testing system during the school year, using Purdue’s own BSL-2 level laboratory for fast results. Anyone showing symptoms will be tested promptly, and quarantined if positive, in space we will set aside for that purpose.
We expect to be able to trace proximate and/or frequent contacts of those who test positive. Contacts in the vulnerable categories will be asked to self-quarantine for the recommended period, currently 14 days. Those in the young, least vulnerable group will be tested, quarantined if positive, or checked regularly for symptoms if negative for both antibodies and the virus.
This paper provides details on transforming a university lab into a testing center. In essence, a major university with a hospital (which Purdue doesn’t have) should be able to do it technically but to work to reopen for students it probably has to be a university located outside of a major urban area. Here are a few possibilities:
- Baylor University
- Vanderbilt University
- University of Michigan, Ann Arbor
- University of Virginia
- University of Iowa
- University of Utah
- University of Alabama
Mitch Daniel also notes:
Our campus community, a “city” of 50,000+ people, is highly unusual in its makeup. At least 80% of our population is made up of young people, say, 35 and under. All data to date tell us that the COVID-19 virus, while it transmits rapidly in this age group, poses close to zero lethal threat to them.
which does seem to miss (ahem) an important group necessary for reopening.
I found it interesting throughout, the first half was on Covid-19 testing, and the second half on everything else. Here is the audio and transcript. Here is the summary:
Tyler invited Glen to discuss the plan, including how it’d overcome obstacles to scaling up testing and tracing, what other countries got right and wrong in their responses, the unusual reason why he’s bothered by price gouging on PPE supplies, where his plan differs with Paul Romer’s, and more. They also discuss academia’s responsibility to inform public discourse, how he’d apply his ideas on mechanism design to reform tenure and admissions, his unique intellectual journey from socialism to libertarianism and beyond, the common element that attracts him to both the movie Memento and Don McLean’s “American Pie,” what talent he looks for in young economists, the struggle to straddle the divide between academia and politics, the benefits and drawbacks of rollerblading to class, and more.
Here is one excerpt:
WEYL: There’s one really critical element of this plan that I don’t think has been widely discussed, which is that there are 40 percent of people in the essential sector who are still out there doing their jobs. There may have been some improvements in sanitation. There probably have been, though there have been a lot of issues with getting the PPE required to do that.
But those people are basically transmitting the diseases they always have been. And so, by far, our first priority has to be not “reopening the economy,” but rather stabilizing that sector of the economy so that transmission is not taking place within that sector.
Once we’ve accomplished that goal, it will actually be relatively easy to reopen the rest of the economy, given that that’s 40 percent. It’s just a doubling to get to everybody being in a disease-stabilized situation. So I really think the focus has to be on stabilizing the essential sector by building up this regimen. I think we can do that by the end of June.
Once that’s accomplished, I think we can, over the course of July, reintroduce most of the rest of the economy and have the confidence that, because we haven’t seen reemergence of diseases within the essential sector, that reintroducing everybody else will proceed in a similar fashion.
COWEN: Other than possibly the adoption of your plan, what do you think will be the most enduring economic or social change from this pandemic?
WEYL: My guess is that there will be a lot of large corporations that take on important social responsibilities because of the trust environment that you were talking about and that it becomes increasingly illegitimate for them to be run under a pure shareholder-maximization perspective once they’re taking on that role. I think we’re going to see fundamental shifts in some of the corporate governance parameters as a result of the social role that a bunch of companies end up taking on.
COWEN: At heart, coming out of the Jewish socialist tradition, through a matter of biographical accident, you first became a libertarian. Needed time to find your way back to the tradition you belonged to. Along the way, did economics, so you believe in some notion of markets, albeit directly adjusted by regulation and mechanism design. And you’ve moved away from methodological individualism.
But you’re this weird person of a Jewish socialist, believes in markets, and had this path leading away from libertarianism. No other person in the world probably is that, but you are. Is that a unified theory of you?
WEYL: Well, the thing that throws a little bit of a wrench into that is that I was actually a Jewish socialist before I became a libertarian.
COWEN: Does that strengthen or weaken the theory?
For me the most instructive part was this:
COWEN: What do you view yourself as rebelling against? At the foundational level.
But you will have to read or listen to hear Glen’s very good answer.
5. NYT covers Sweden. In my view we still don’t know how well the Swedish experiment is working out, but a continuing verdict of “we still don’t know” does in fact favor Sweden relative to priors. And Thomas Friedman (NYT) on Sweden. And update on some Swedish numbers.
6. A reader email on why child abuse is not opposed more passionately: “Basically, I think it comes down to the problem of agency vs structure. The left (including myself) wants to emphasize that problems have large structural components so we need to change the system. However individual heinous acts don’t fit neatly into that paradigm. Plus, child abuse is pervasive enough that it is sort of structural itself, and talking about it can sound like blaming a community or demographic, or hitting close to racism. No idea why the right doesn’t emphasize it more other than the idea that it’s somehow “traditional”?”
7. Mel Baggs, disability advocate, RIP (NYT). Formerly known as Amanda Baggs.
8. Quarantine stereotypes (video, funny, some of it).
9. Will colleges lose twenty percent of their student body this year? Solve for the equilibrium.
10. Jason Furman: “If you had told me we would have a massive pandemic I would have predicted an increase in health spending. Shows why you shouldn’t listen to me. Health spending down 4.9% in Q1 (not annualized). Responsible for nearly 1/2 of the overall GDP decline. Likely down much more in Q2.” Correctly or not, that makes me feel better about the observed gdp decline. I am not minimizing the import of the non-Covid extra death toll (which is what exactly? Is it net even positive?), but I already felt bad about that.
These would seem to be some important results:
To model COVID-19 spread, we use an SEIR agent-based model on a graph, which takes into account several important real-life attributes of COVID-19: super-spreaders, realistic epidemiological parameters of the disease, testing and quarantine policies. We find that mass-testing is much less effective than testing the symptomatic and contact tracing, and some blend of these with social distancing is required to achieve suppression. We also find that the fat tail of the degree distribution matters a lot for epidemic growth, and many standard models do not account for this. Additionally, the average reproduction number for individuals, equivalent in many models to R0, is not an upper bound for the effective reproduction number, R. Even with an expectation of less than one new case per person, our model shows that exponential spread is possible. The parameter which closely predicts growth rate is the ratio between 2nd to 1st moments of the degree distribution. We provide mathematical arguments to argue that certain results of our simulations hold in more general settings.
And from the body of the paper:
To create containment, we need to test 30% of the population every day. If we only test 10% of the population every day, we get 34% of the population infected – no containment (blue bars).
As for test and trace:
Even with 100% of contacts traced and tested, still mass-testing of just over 10% of the population daily is required for containment.
The authors are not anti-testing (though relatively skeptical about mass testing compared to some of its adherents), but rather think a combination is required in what is a very tough fight:
Our simulations suggest some social distancing (short of lockdown), testing of symptomatics and contact tracing are the way to go.
That is all from a new paper by Ofir Reich, Guy Shalev, and Tom Kalvari, from Google, Google, and Tel Aviv University, respectively. Here is a related tweetstorm. With this research, I feel we are finally getting somewhere.
From an anonymous reader:
As you are of course aware, testing on vaccines for Covid-19 are beginning to be undertaken. The scientific community has seemingly decided that Human Challenge Trials (HCT) where test subjects are directly exposed to the virus following vaccination are unethical, instead using the typical protocol of vaccine/placebo inoculation followed by months of observation in order to observe effectiveness. This seems to me a grave moral error based on the following argument.
1) There exists a large cohort of young, healthy, fully informed, willing participants who would undergo HCT.
2) Given the mortality profile of this disease, these participants would be undertaking an exceptionally small mortality risk (perhaps 5-10 per 100k, based on data from Spain/Italy/NYC, assuming zero vaccine effectiveness).
3) Society deems acceptable other activities with much higher fatality risk (at least 5-10x) in both professional (soldiers, logging workers) and recreational (motorcycling, mountaineering) capacities.
4) HCT would speed up the vaccine testing process by many months, saving tens of thousands of lives and avoiding enormous economic damage.
5) HCT actually poses significantly less risk to participants in terms of allergic reaction or ADE risk compared to a standard testing protocol since the number of participants could be much smaller and they would be medically observed.
I fail to find any ethical justification for the current stance of the medical community, from either a utilitarian or deontological perspective, and believe a highly consequential error is being made. This error may be based on false analogies to past unethical testing practices in history where participants were not informed or willing and danger was significant. The current case bears no ethical resemblance, in my judgement, to these past cases.
The simplest model of such errors is that many members of the biomedical establishment do not wish to have bad feelings about any “sins of commission” and to see their status lowered as a result of “dirty hands,” and the readily criticized logistics of Human Challenge Trials. Since HCTs do not “feel right” to them, they self-deceive into associating that feeling with a concern for the greater public good.
You should not be surprised to see grave moral errors committed in a crisis, however. Our “mainstream” protection against grave moral errors, in normal circumstances, simply is that usually we are not given the opportunity to commit them.
I do understand that a Human Challenge Trial does not necessarily suffice to show that a given vaccine is safe. Nonetheless it should be in the “armor of our discourse,” so to speak, as a morally acceptable alternative. So if you are a biomedical professional, or a public intellectual, I hope you will speak up.
Savers at the Bank of Nook are being driven to speculate on turnips and tarantulas, as the most popular video game of the coronavirus era mimics global central bankers by making steep cuts in interest rates.
The estimated 12m players of Nintendo’s cartoon fantasy Animal Crossing: New Horizons were informed last week about the move, in which the Bank of Nook slashed the interest paid on savings from around 0.5 per cent to just 0.05 per cent.
The total interest available on any amount of savings has now been capped at 9,999 bells — the in-game currency that can be bought online at a rate of about $1 per 1.9m bells.
The abrupt policy shift, imposed by an obligatory software update on April 23, provoked a stream of online fury that a once-solid stream of income had been reduced to a trickle with the stroke of a raccoon banker’s pen.
“I’m never going to financially recover from this,” one player wrote on a Reddit forum. “Island recession incoming,” said another.
Here is more from the FT, via Malinga Fernando.
2. Very good Derek Thompson piece on the evolution of retail (Atlantic).
4. Mulligan, Murphy, and Topel on Covid-related issues. They think like economists.
6. Osterholm and Olshaker on testing, good piece (NYT).
7. Coronavirus spreading in Africa more slowly than expected (FT but not gated).
8. Forced isolation.
Very well-deserved, here is the full account, including a summary of her research. Excerpt:
Historians (e.g., Engerman and Sokolov) have long argued for the persistence of institutions and the “long shadow” of historical events on developing countries. For example, cross-national studies have noted that Latin America and North America organized labor differently during colonial periods and used cross-country historical data to support the idea that these differences have had long-run impacts. More generally, Acemoglu, Johnson, and Robinson compare the experience of countries with different institutions set in place during colonial time for largely accidental reasons, showing that these early differences continue to matter today.
In her work, Dell goes beyond the cross-country evidence, using historical accidents or peculiarities to shed light on persistent effects of institutional differences, including different in the organization of the state. She exploits historical settings in which she is able to very convincingly establish the persistent impacts of specific institutions as well as explore specific channels through which these impacts occur.
Do read the whole thing. Here are some previous MR posts on Melissa Dell.