Month: January 2021

The end of the Swedish model

The government this week proposed an emergency law that would allow it to lock down large parts of society; the first recommended use of face masks came into force; and the authorities gave schools the option to close for pupils older than 13 — all changes to its strategy to combat the pandemic.

“I don’t think Sweden stands out [from the rest of the world] very much right now,” said Jonas Ludvigsson, professor of clinical epidemiology at Karolinska Institutet in Stockholm. “Most of the things that made Sweden different have changed — either in Sweden or elsewhere.”

…Sweden has reported more than 2,000 Covid-19 deaths in a month and 535 in the past eight days alone. This compares with 465 for the pandemic as a whole in neighbouring Norway, which has half the population. As Sweden’s King Carl XVI Gustaf said just before Christmas: “We have failed.”

Here is more from the FT.  U.S. Covid deaths per day have now exceeded 4,000 for some days, and they are running at about 50% of the normal number for total daily deaths.  And no, it is not that the payments to classify these as Covid deaths have increased, rather the virus and the deaths have increased.  So the “no big deal” question we now can consider settled?  The new and more contagious strains haven’t even started playing a major role yet in the United States.

“Second Doses” post-mortem

The most striking thing about the Biden administration shift to a version of “First Doses First” is how little protest there has been.  Given how many public health experts were upset about the idea only a few days ago, you might expect them to organize a Wall Street Journal petition from hundreds of their colleagues: “Biden administration proposal endangers the lives of millions of Americans.”

But of course they won’t do that.  Some of that is pro-Democrat partisanship, but that is not even the main factor.  One reason is that public health experts, with their medical and quasi-medical backgrounds, typically have very little sense of how to respond in the public arena if challenged.  For instance, not a single one stepped forward with a calculation to defend “Second Doses.”  They are not especially good at “the internet rules of the game,” which of course are now supreme (not always for the best, to be clear).

The second and probably most important reason is that, as I had explained, sins of omission are treated as far less significant than sins of commission.  Now that a version of “First Doses First” is on the verge of becoming policy, to do nothing about that is only a sin of omission, and thus not so bad.  Remarkable!  Status quo bias really matters here.

I haven’t seen a single peep on Twitter opposing the new policy.

Just keep all this in mind the next time you see a debate over public health policy.  There is often less behind the curtain than you might think.

Quantum Technology for Economists

That is the title of a new paper by Isaiah Hull, Or Sattath, Eleni Diamanti, and Goran Wendin.  Much of it I did not understand, but maybe you will.  Here is one excerpt:

Our overview of quantum money starts with a full description of the original scheme, which was introduced circa 1969, but only published later in Wiesner (1983). We will see that it achieves what is called “information-theoretic security,” which means that an attacker with unbounded classical and quantum resources will not be able to counterfeit a unit of the money. Since this original scheme was proposed, the term “quantum money” has come to refer to a broad variety of different payment instruments, including credit cards, bills, and coins, all of which use of quantum physical phenomena to achieve security.The real promise of quantum money is that it offers the possibility of combining the beneficial features of both physical cash and digital payments, which is not possible without the use of the higher standard of security quantum money offers.In particular, a form of currency called “public-key” quantum money would allow individuals to verify the authenticity of bills and coins publicly and without the need to communicate with a trusted third party. This is not possible with any classical form of digital of money, including cryptocurrencies, which at least require communication with a distributed ledger. Thus, quantum money could restore the privacy and anonymity associated with physical money transactions, while maintaining the convenience of digital payment instruments.

Makes those crypto people look like David Laidler!  See also this Behera and Sattath paper.

First Doses First, coming soon to a state near you…

Of course on this particular issue, Alex was the one who started the intellectual campaign…

Friday assorted links

Be Prepared! Sars-COV-3

The federal government was unprepared for the pandemic, despite multiple, loud and clear warnings. State and local governments were unprepared for vaccines, despite multiple, loud and clear warnings. The Capitol Police were unprepared for rioters, despite multiple, loud and clear warnings.

The record isn’t good but as a Queen’s Scout I persist. We now have multiple, loud and clear warnings that new variants of the SARS-COV II virus are more transmissible and thus much more dangerous. But we can do something. As wrote in The New Strain and the Need for Speed

One of the big virtues of mRNA vaccines is that much like switching a bottling plant from Sprite to 7-Up we could tweak the formula and produce a new vaccine using exactly the same manufacturing plants. Moreover, Marks and Hahn at the FDA have said that the FDA would not require new clinical trials for safety and efficacy just smaller, shorter trials for immune response (similarly we don’t do new large-scale clinical trials for every iteration of the flu vaccine.) Thus, if we needed it, we could modify mRNA vaccines (not other types) for a new variant in say 8-12 weeks.

Thus, let’s start doing much more sequencing to discover new strains–and also think about potential new strains–and start phase I and phase II trials of new vaccines. Florian Krammer suggested an even more ambitious plan to do the same thing for all potential pandemic viruses:

From each of the identified virus families, which should certainly include the Paramyxoviridae, Orthomyxoviridae, and Coronaviridae families, a handful of representative strains with the highest pandemic potential should be selected for vaccine production. Up to 50–100 different viruses could be selected and this would broadly cover all phylogenies that may give rise to pandemic strains….It should be possible to choose candidates that are close to viruses that might emerge in the human population. The idea is that once viruses are selected, vaccines can be produced in different platforms and tested in phase 1 and phase 2 trials with some of the produced vaccine being stockpiled. This would likely cost 20–30 million US dollars per vaccine candidate resulting in a cost of 1–3 billion US dollars.

What I am suggesting is less ambitious–just do this for Sars-COV-3, 4, 5 and 6. But do it now!

Hat tip: Daniel Bier.

Broken Record Addendum: We should make better use of our limited vaccine supply by moving to First Doses First and/or fractional dosing and approve the AstraZeneca vaccine immediately and spend billions to increase the rate of vaccinations and to speed new vaccines (such as those from J&J and Novavax) to market.

A legal and regulatory question about First Doses First

It isn’t clear to me who in the United States is legally entitled to make this decision.  An FDA EUA is required before a vaccine can be used in the U.S.  But once an EUA has been issued, is “off-label use” permitted?  The CDC’s Advisory Committee on Immunization Practices recommends how scarce vaccine doses should be prioritized, but “states” (governors?) are free to make contrary prioritization decisions.  Can states also decide to give half-doses or lengthen the interval between first and second doses?  Can a hospital, a nursing home, or an individual doctor make such a decision?  (If so, can it also deviate from its state prioritizations?)  Can HHS or the President specify how these decisions must be made, or alternatively can they explicitly free lower-level decision-makers to use their own judgment?

You’re not a specialist in pharmaceutical law, I realize.  But I doubt you’ll let that stop you!  When you recommend a less risk-averse approach to COVID-19 vaccination, to whom are you addressing the recommendation?  Who has a right to implement it?

That is from MR reader Peter Sandman.  Can any MR reader inform us on this?

Mass vaccination for Virginia (from my email)

A vaccination center with 4 vaccination stations requiring 58 staff (only 16 of which seem to need medical training to prepare and administer vaccines and 1 EMT on hand for adverse reactions (I imagine med students and military/other governmental personnel could also be used in this endeavor)) working a total of 16 hours/day (i.e. 2 shifts) is estimated to be able to vaccinate 1900 people per day.

If there were 50 of these across Virginia, the entire population could be given one dose in 90 days. Given that 2 doses are required, you could get the vaccination done by summer (if there were no supply constraints). With 30 vaccination centers, Virginia could be done distributing its 317,000 remaining unadministered doses in 5 days. Instead, Virginia reported 828 vaccinations yesterday. (I’m hoping Virginia is already finished with nursing facilities since Kaiser estimates that Virginia only had 19,900 residents in skilled nursing facilities in 2019).

And staffing is easily solved. 30 vaccination centers require 480 medical personnel to prepare and administer the vaccine and 30 EMTs. There are about 120,000 nurses in Virginia. Chances are, more than 480 nurses were on vacation for longer than 5 days at some point this past year so it won’t cripple the healthcare system. Getting 1 percent of the nursing workforce for this should not be that hard (and that’s not including med students and military/other governmental personnel who could also aid in this endeavor).

What boggles my mind is the number of staff they have allocated for paperwork.

If the US had been prepared, it could’ve set up a system of vaccination tickets with QR codes (much like tickets for air travel or going to a sporting event) that could be handed out by primary care physicians, hospitals, etc. (or just based on administrative records of age). Those would transfer the relevant data that would have been collected by the paperwork people. People would schedule a slot via some app (even doctors’ offices have online scheduling now), show up, provide ID verification, and get the shot. So you could open up a vaccination center with less staff. I get that not everyone has a smartphone, but seriously, this is not that hard.

The more you think about how many times large logistics problems are solved every single day by 100s and 1000s of organizations, the performance of the US just looks worse and worse.

From a loyal (and anonymous) MR reader.

Thursday assorted stupid links

1. Redux of my 2017 column on Trump and Shakespeare.

2. “Zero? You think there’s something special about that number!?”  Update: now there is a statement, apparently the police do not feel the need to be ready for criminal activities.  Just read the second to last paragraph and let your jaw drop.  And here is a short video of note.

3. This man (short video) does not favor the reign of Bob Murphy.  And if only so much R&D was being done!

4. Tyler Goodspeed resigns from CEA.

From the comments, on Congressional cybersecurity, from Gomer

Here’s a new service sector job: Capitol IT admin. The staffers left their computers unlocked when the building was stormed. All it takes is one bad actor to infect the network with malware or steal top secret data. Those rioters broached the physical security of the building so all machines are considered compromised and have to be rebuilt from the ground up. The buildings will also have to be scanned for bugs, wires, and other spook stuff. A state actor hiding in the mob could do some serious damage to national security. Not hard to imagine those Trumpies opening the doors to let an agent from China, Iran, or Russia on to the floor of the Senate. An unknowing useful idiot is still a useful idiot. If this isn’t a coup then this is a serious, serious transgression.

You don’t have to think these are the major cybersecurity threats to USG to find this situation intolerable.  There are also reports of Molotov cocktails and pipe bombs in or near Congress.  You simply have to secure the physical building if you are to have credible security at all.  I am very familiar with these entrances, and even an outnumbered force has the ability to keep out intruders, if it has the will to do so.  In contrast, the Secret Service has a long history of agents using their bodies to block or shield presidents from threats of violence.  Does Congress as a whole (which is harder to replace than a single president) deserve any less?

Those new service sector jobs

Neal Katyal has argued 43 cases before the Supreme Court. Until the coronavirus pandemic hit, he hadn’t once enlisted his son as an assistant.

Now, Mr. Katyal and other lawyers appearing in the nation’s highest court have to argue their cases remotely, which often means from home. In November, as Mr. Katyal prepared in his home office to represent the city of Philadelphia in a case about religious objections to same-sex parents, he worried about the street noise.

So he gave his 19-year-old son $100 and instructed him to go outside and dole out cash to quiet down any noisemakers. Sure enough, minutes before the hearing began, a truck rolled up, idling loudly.

“Oh my God, the justices are going to be so mad at me,” Mr. Katyal, who served as acting solicitor general in the Obama administration, recalled thinking. Fortunately, the truck drove away without his son having to intercede.

Here is the full WSJ article.

Austin Vernon on crypto (from my email)

I think your column agrees with my mental model in that the actual crypto networks may not be regulated, but the on-ramps and off-ramps will be heavily regulated (and already are).

If you are an exporter being paid in crypto assets by a Nigerian importer, the obvious thing to do is hedge that crypto against your currency of choice. Because of the volatility, this is maybe most analogous to oil companies hedging oil sales. It is a common practice that most energy lenders provide as part of their menu.

If you tried to set up a service to do this without following the current regulations, I’m sure you’d end up in prison. Just like Coinbase or USDC is already regulated under current rules, hedging crypto against the dollar would easily fall under CFTC rules. Your bank that already provides a line of credit and knows your order book would be the one to offer the service.

I think this is a good outcome in that for those so inclined, the crypto networks provide high risk but low regulation pathways to do business. Everybody else that wants to straddle the dollar and crypto world to get some benefits of crypto will still use the same institutions that manage the massive amounts of regulation that exists in the dollar world.

Maybe the best way to look at the future of crypto, especially outside of bitcoin, is that it is the perfect open-source software ecosystem. Everything is easily interoperable, security is high, and there is a business model for paying developers. Linux and Unix never became consumer operating systems, but they underly every website you use, every popular phone operating system, and now both macOS and Windows. Crypto can do that for financial systems and other applications by providing the infrastructure for advanced (and regulated) consumer and enterprise apps to be built on. It is more like Marc Andreessen’s “software is eating the world” than crypto anarchy. The crypto-anarchists will always have Monero!