Category: Current Affairs

The case for geographically concentrated vaccine doses

Here goes:

A central yet neglected point is that vaccines should not be sent to each and every part of the U.S. Instead, it would be better to concentrate distribution in a small number of places where the vaccines can have a greater impact.

Say, for the purposes of argument, that you had 20,000 vaccine doses to distribute. There are about 20,000 cities and towns in America. Would you send one dose to each location? That might sound fair, but such a distribution would limit the overall effect. Many of those 20,000 recipients would be safer, but your plan would not meaningfully reduce community transmission in any of those places, nor would it allow any public events to restart or schools to reopen.

Alternatively, say you chose one town or well-defined area and distributed all 20,000 doses there. Not only would you protect 20,000 people with the vaccine, but the surrounding area would be much safer, too. Children could go to school, for instance, knowing that most of the other people in the building had been vaccinated. Shopping and dining would boom as well.

Here is one qualifier, but in fact it pushes one further along the road to geographic concentration:

Over time, mobility, migration and mixing would undo some of the initial benefits of the geographically concentrated dose of vaccines. That’s why the second round of vaccine distribution should go exactly to those people who are most likely to mix with the first targeted area. This plan reaps two benefits: protecting the people in the newly chosen second area, and limiting the ability of those people to disrupt the benefits already gained in the first area.

In other words, if the first doses went (to choose a random example) to Wilmington, Delaware, the next batch of doses should go to the suburbs of Wilmington. In economics language [behind this link is a highly useful Michael Kremer paper], one can say that Covid-19 infections (and protections) have externalities, and there are increasing returns to those externalities. That implies a geographically concentrated approach to vaccine distribution, whether at the federal or state level.

Here is another qualifier:

…there will be practical limits on a fully concentrated geographic distribution of vaccines. Too many vaccines sent to too few places will result in long waits and trouble with storage. Nonetheless, at the margin the U.S. should still consider a more geographically concentrated distribution than what it is likely to do.

Do you think that travel restrictions have stopped the spread of the coronavirus? (Doesn’t mean you have to favor them, all things considered.)  Probably yes.  If so, you probably ought to favor a geographically concentrated initial distribution of the vaccine as well — can you see why it is the same logic?  Just imagine it spreading out like stones on a Go board.

Of course we are not likely to do any of this.  Here is my full Bloomberg column.

The pandemic is indeed a big deal

In our estimation, and with standard preference parameters, the value of the ability to end the pandemic is worth 5-15% of total wealth. This value rises substantially when there is uncertainty about the frequency and duration of pandemics. Agents place almost as much value on the ability to resolve the uncertainty as they do on the value of the cure itself.

That is from a new NBER working paper by Viral V. Acharya, Timothy Johnson, Suresh Sundaresan, and Steven Zheng.  Their analysis also shows that preventing or limiting future pandemics may be a bigger deal yet.

Rapid Antigen Tests in Europe

Image‘If rapid antigen tests are so good how come other countries aren’t using them’? is a question I get asked a lot. In fact, India authorized these tests months ago. Slovakia tested most of their population using antigen tests. Germany is using them to protect nursing home residents. Lufthansa is trialing rapid antigen tests on special flights. Rapid antigen tests are now beginning to be available more widely in Europe. Here from a twitter thread is a picture of what they look like, it’s just a paper strip inside. You swab your nose (no need for deep cleaning), swirl the swab in a tube with some liquid and then squeeze a few drops of the liquid onto the end of the tester. Results in 15 minutes. They cost about $8 a test.

Why are these tests important? The CDC now says that asymptomatic or pre-symptomatic people account for a majority of infections. Do you get it? How many people without symptoms will get a COVID PCR test, which can be time consuming and expensive? (And how many PCR tests can we run in a timely fashion if people without symptoms get many more tests?) Not that many. But many people without symptoms would get a $8 or less, at-home, 15 minute test. And if some of those people discover that they are infectious and self-isolate for a few days we can drive infection rates down.

We should have had an Operation Warp Speed for tests. We still need funding for a mass rollout and, of course, the FDA needs to approve these tests! (Here is Michael Mina in Time fulminating at the FDA holdup.)

By the way, more than 2800 Americans have died of COVID since Pfizer requested an Emergency Use Authorization for their vaccine. The FDA meets Dec. 10.

Addendum: Here’s me explaining why Frequent, Fast, and Cheap is Better than Sensitive and the difference between infected and infectious.

Vaccination economic resumption sentences to ponder

If you think of state governments as basically being as permissive as possible consistent with not overwhelming their hospital systems then even vaccinating 20% of the population has a huge economic impact as long as it’s targeted in a halfway plausible way.

That is from Matt Yglesias.  I would stress also the bad news that in the meantime many Americans (other citizens too!) are becoming infected.  I haven’t seen recent serological results, but quite some time ago the range already was 10-15% of America infected.  It seems entirely plausible to think that many parts of the country (not SF, not Vermont) will be at 30% or higher infected by February.  Plus 20% getting vaccinated, and still likely a residue of the population with above average protective immune response, and by that I mean relative to age group.

So overalI I am more optimistic about the spring than are many of the people I am talking to.  And the United States may well be the first country to arrive at a semblance of herd immunity, albeit not the way we might have preferred.

Progress against HIV-AIDS hasn’t been reported enough

While an effective vaccine against HIV may still be a long way off, a new HIV prevention technique has proven remarkably effective at protecting women against the virus.

A single injection of a drug called cabotegravir every two months was so successful in preventing HIV in a clinical trial among women in sub-Saharan Africa that the study was wrapped up ahead of schedule.

The study, run by the HIV Prevention Trials Network, was looking at two forms of pre-exposure prophylaxis or (PrEP) aimed at women. PrEP is a technique of administering low doses of anti-AIDS drugs to people who are HIV negative as a way to protect them from infection. The study compared the effectiveness of the new long-acting injectable against the current form of PrEP, a daily pill of Truvada.

The findings were announced by the study’s researchers on Monday.

“This is a major, major advance,” said Dr. Anthony Fauci in a briefing. The director of the National Institute of Allergy and Infectious Diseases, which was involved in the study, Fauci has spent much of his career working on HIV/AIDS.

Here is the full NPR report, here is NYT coverage. Yes, it still needs to be easier to deliver.  But how many Americans, right now, could identify what cabotegravir is?  As I said earlier this morning, the great stagnation may be ending.

Is the Great Stagnation over?

– A working mRNA vaccine (first ever in humans!),

– Apple M1 chip,

– SpaceX rocket launch,

– GPT-3,

– Tons of cool companies IPO’ing and tons more getting started,

– V-shaped recovery

– Electric cars

– Crypto going mainstream

That is from a tweet by Nabeel S.Qureshi.  One could add warp speed, affordable solar power, the eggplant, and distanced work to that list, the latter also implying significant rent declines and child care cost declines for many people.

Around the time The Great Stagnation came out in 2011, I predicted that it was most likely to end within the next twenty years.  We are not there yet, but that claim is no longer looking so absurd.

Note that the vaccine-driven recovery will measure as a rise in labor inputs, but in reality it will be pure TFP.  In 2021 (but which quarter?), true TFP will be remarkably high, maybe the highest ever?

The Chilean pension system is in crisis

Chile’s celebrated $200bn private pensions system has served as a model for dozens of emerging markets since it was introduced in the 1980s. Now, it faces an existential crisis as public support for the model fades and populist politicians allow savers to withdraw funds during the coronavirus crisis.

The lower house of congress voted to allow Chileans to withdraw another 10 per cent of their pension funds last week, following a similar measure in July that saw withdrawals of some $17bn.

Congress could yet approve a third withdrawal next year, putting at risk a pool of savings that has driven the growth of Chile’s capital markets and jeopardising future returns.

That is from Benedict Mander and Michael Stott at the FT.  Of course you can say “Ah, they shouldn’t do that!”  And they should not.  Still, at the end of the day if you leave surpluses sitting around to be grabbed or handed out, don’t be surprised if they are grabbed or handed out.  Arguably the famed Chilean scheme has been shown to be time-inconsistent.  It was, however, nice while it lasted.

Post-Covid, is the U.S. falling behind China?

I don’t think so, as I argue in my latest Bloomberg column, here is one bit:

If you are wondering whether China or the U.S. with its allies is more likely to make a big breakthrough, in, say, quantum computing, ask yourself a simple question: Which network will better attract talented immigrants? The more that talent and innovation are found around the world, the more that helps the U.S.

And:

Perhaps most important, the European Union has evolved from seeing China primarily as a customer to seeing China primarily as a rival. Even Germany, a longstanding advocate for closer ties with China, has become more skeptical. Furthermore, most European nations have ended up agreeing with the U.S. that Chinese telecom giant Huawei be kept out of the critical parts of their communications infrastructure.

It is also worth noting that GPT-3 came out of the Anglosphere, not China, even though we have been hearing for years that China may be ahead in AI.

Asking for a friend

What is the current take on foreign interference in the 2020 presidential election?  I hardly hear anyone mentioning this.  Was there much?  And if not, why not?  Our sagest minds were warning of this for years, and I heard several nat sec experts warn me of this but a few weeks ago.  There have been hundreds of media articles about the topic.  So what is up?  I see a few options:

1. There was lots of foreign interference (again), but things turned out OK so it is not a major issue.  “Never mind.”

2. President Donald Trump ensured election integrity through vigilance, good policy, and cooperation with Vladimir Putin.

3. Local election authorities were alert this time around, and they choked off each and every instance of foreign election interference.

4. The major tech companies were alert this time around, and they choked off each and every instance of foreign election interference.  They didn’t even let the Russkies spend 60k on Facebook ads.  Those are such great companies.

5. Foreign election interference was never much of a significant issue to begin with.  “Never mind.

6. Foreign powers are now all, in each and every country, committed to free and fair American elections, and they acted accordingly.

To be clear, I am not asking which is true.  I am asking which one I am supposed to believe.

Sunny Days Protect Against Flu

Vitamin D supplementation is cheap. Walking in sunlight is even cheaper. I’ve been doing more of both since the beginnings of the pandemic. Slusky and Zekhauser add to the evidence:

Sunlight, likely operating through the well-established channel of producing vitamin D, has the potential to play a significant role in reducing flu incidence. A recent meta-analysis of 25 randomized controlled trials of vitamin D supplementation (Martineau et al. 2017) demonstrated significant benefits of such supplements for reducing the likelihood that an individual will contract an acute upper respiratory infection. The current study considers sunlight as an alternate, natural path through which humans can and do secure vitamin D. This study’s findings complement and reinforce the Martineau et al. findings.

Our major result is that incremental sunlight in the late summer and early fall has the potential to reduce the incidence of influenza. Sunlight had a dramatic effect in 2009, when sunlight was well below average at the national level, and the flu came early. Our result is potentially relevant not just to the current COVID-19 pandemic, but also to a future outlier H1N1 pandemic. The threat is there; some H1N1 viruses already exist in animals (Sun et al. 2020). One must be cautious, though, with generalizations, given the unique economic circumstances (e.g., a 25-year high unemployment rate) in the fall of 2009.

A remaining question is whether sunlight matters more broadly for flu, or whether it is unique to H1N1. While we lack a counterfactual of an early flu from a different strain, we do have two pieces of evidence to suggest that the effect is broader than just H1N1. First, as described throughout the paper, the Martineau et al. study about the relationship between Vitamin D and upper respiratory infections are not specific to H1N1. Second, with granular, county level data, we do see strongly statistically significant negative effects of fall sunlight on influenza for years other than 2009 (see Columns (2) and (3) of Panel of Table 7). Therefore, apart from its methodological contributions, this study reinforces the long-held assertion that vitamin D protects against acute upper respiratory infections. One can secure vitamin D through supplements, or through a walk outdoors, particularly on a day when the sun shines brightly. When most walk, herd protection provides benefit to all.

The Scots are giving out free vitamin D to people stuck indoors. My view is that Vitamin D supplementation is worthwhile but where and when possible the sunlight approach is better as the effect may work through mechanisms beyond vitamin D.

Coincidentally neuroscience says this is one of the happiest songs ever.

Hat tip: The sunny Kevin Lewis.

Emergent Ventures winners, eleventh cohort

Andrew Dembe of Uganda, working on the “last mile” problem for health care delivery.

Maxwell Dostart-Meers of Harvard, to study Singapore and state capacity, as a Progress Studies fellow.

Markus Strasser of Linz, Austria, now living in London, to pursue a next-generation scientific search and discovery web interface that can answer complex quantitative questions, built on extracted relations from scientific text, such as graph of causations, effects, biomarkers, quantities, etc.

Marc Sidwell of the United Kingdom, to write a book on common sense.

Yuen Yuen Ang, political scientist at the University of Michigan, from Singapore, to write a new book on disruption.

Matthew Clancy, Iowa State University, Progress Studies fellow. To build out his newsletter on recent research on innovation.

Samarth Athreya, Ontario: “I’m a 17 year old who is incredibly passionate about the advent of biomaterials and its potential to push humanity forward in a variety of industries. I’ve been speaking about my vision and some of my research on the progress of material science and nanotechnology specifically at various events like C2 Montreal, SXSW, and Elevate Tech Festival!”

Applied Divinity Studies, this anonymously written blog has won an award for his or her writing and blogging.  We are paying in bitcoin.

Jordan Mafumbo, a Ugandan autodidact and civil engineer studying Heidegger and the foundations of liberalism.  He also has won an award for blogging.

Sweden Covid-19 update

Do not judge Sweden until the autumn. That was the message from its state epidemiologist Anders Tegnell in May and through the summer as he argued that Sweden’s initial high death toll from Covid-19 would be followed in the second wave by “a high level of immunity and the number of cases will probably be quite low”.

Now the autumn is here, and hospitalisations from Covid-19 are currently rising faster in Sweden than in any other country in Europe, while in Stockholm — the centre for both the first and second waves in the country — one in every five tests is positive, suggesting the virus is even more widespread than official figures suggest.

Even Sweden’s public health agency admits its earlier prediction that the country’s Nordic neighbours such as Finland and Norway would suffer more in the autumn appears wrong. Sweden is currently faring worse than Denmark, Finland and Norway on cases, hospitalisations and deaths relative to the size of their population.

…The number of patients hospitalised with Covid-19 is doubling in Sweden every eight days currently, the fastest rate for any European country for which data is available. Its cases per capita have sextupled in the past month to more than 300 new daily infections per million people, close to the UK and way ahead of its Nordic neighbours.

Here is more from Richard Milne at the FT.  To be clear, it seems that many of the Swedish deaths are due to a “dry tinder” effect, so in relative terms they are not doing as much worse than you might think. Other parts of Europe may well catch up to them, at least on a “tinder-adjusted” basis.  But if you are just asking which predictions of which model are being vindicated here, it is that the herd immunity obtained through a partial neutralization of super-spreaders is temporary rather than permanent.

Source here. And Swedish deaths seem to be 40% of the U.S. equivalent.

To be clear, I did not predict this (or its opposite), but rather for many months I have been saying we need more data from Sweden to draw a conclusion.  Now we have more data.

UAE China fact of the day

Rochelle Crossley has been working as a flight attendant in the UAE and received a COVID-19 vaccination after thousands of injections were rolled out to frontline workers.

“The fear of getting the virus outweighed the fear of having the vaccination,” Ms Crossley told 9News.

I am glad to see somebody computing expected value. By the way, that is Sinopharm, not Sinovac.  And:

More than 30,000 people in the UAE have received injections as part of phase three trials.

Here is the article, via Air Genius Gary Leff.

That was then, this is now, wartime casualties edition

U.S. Civil War combat deaths per day: 449

World War II U.S. combat deaths per day: 297

Covid-19 U.S. deaths per day: > 1,000

And rising, 1500 per day seems baked in, 2000 per day might also be within reach.  I just don’t get you people who say this isn’t a big deal.

By the way, deaths as a percentage of population isn’t the right metric here.  Losing 320,000 lives (including excess deaths) has about the same moral import, whether or not there are a billion Morlocks living under the earth’s surface, though that fact would change the loss greatly as measured in percentage terms and of course make it look much smaller.

If one thousand lives (and more) per day is not a big deal, then what is?  The global toll is much larger of course, and most of the gdp contraction has come from fear rather than lockdowns per se — see for instance Sweden.

And as Scott Gottlieb tweeted:

This is not a question of lockdowns vs no lockdowns. The question is how do we take targeted measures, get broader compliance to prudent steps like masks, distancing, avoiding large gatherings; to reduce, slow spread so that the healthcare system doesn’t risk getting overwhelmed.

You won’t do a bit of restraint to stem these losses, and shift infections into the future, while a good vaccine is coming not to mention other therapeutics?  Or try this simple question: If you are a limited government libertarian, then when would you deploy government action if not now?

Speaking of “that was then, this is now,” here is Jeffrey Tucker of AIER (of GBD fame) predicting, circa October 14, that there will never be a vaccine.