Category: Current Affairs

Covid-19 in Kenya

Let’s hope this is true!:

Policy makers in Africa need robust estimates of the current and future spread of SARS-CoV-2. Data suitable for this purpose are scant. We used national surveillance PCR test, serological survey and mobility data to develop and fit a county-specific transmission model for Kenya. We estimate that the SARS-CoV-2 pandemic peaked before the end of July 2020 in the major urban counties, with 34 – 41% of residents infected, and will peak elsewhere in the country within 2-3 months. Despite this penetration, reported severe cases and deaths are low. Our analysis suggests the COVID-19 disease burden in Kenya may be far less than initially feared. A similar scenario across sub-Saharan Africa would have implications for balancing the consequences of restrictions with those of COVID-19.

Here is the full paper.

Should NBA referees call fouls objectively in playoff games?

I call them “rule of law” foul calls, because they are in accord with clearly defined standards for a foul call.  In contrast, in the “good ol’ days” referees used to think: “I’m not going to let a foul call determine the outcome of this playoff game in the decisive moments.”  So unless the defender really slugged the guy, or whacked his hand down when shooting, the refs would “let them play,” and the chips would fall as fate determined.

But Wednesday night I saw three critical foul calls (across two games) in the closing moments that were all “marginal fouls.”  They were, in my opinion (and in the opinion of former referee Steve Javie), all legitimate foul calls.  But just barely, and I am pretty sure that none of them would have been called fifteen years ago, or maybe not even five years ago.  Bumping into a guy after he already missed his shot and the clock ran out?  Is it a foul objectively speaking?  Yes.  Should it be called?  Well…

The case against rule of law fouls is that games decided by the referees have less legitimacy, and that in turn hurts both the legitimacy and the popularity of the league.  Even if it was “objectively a foul,” the fans either don’t know that, were unwilling to recognize that, or they may, like I, favor the good ol’ days when fouls were called less objectively and also less frequently in the closing moments of close games.

The case in favor of rule of law foul calls is that replays and social media make the truth easier to determine, and place extra burden on the refs to appear fair and consistent over time, to protect the legitimacy and popularity of the league.  Furthermore, the heightened salience of racial issues encourages a more consistent standard to limit charges of discrimination, whether those charges are founded or not.  It is more defensible to always call the same play the same way, regardless of the clock or the closeness of the score, which are ultimately somewhat subjective standards (just how close does the game have to be?).

So I recognize that rule of law foul calls may now be necessary, even if I do not myself prefer them.

One relevant point here is that with better recording and a wider dissemination of the recordings, the NBA has in fact moved much closer to the rule of law.

So it can be done, and perhaps others can do it too.  Just like the spit testing.

Addendum from the comments: “The real reason must be gambling – they want gambling on the NBA to be legitimate, and this causes a lot of problems if the refs have a lot of latitude to make choices. The NBA has had problems with this.”

On vaccine timing, from the comments

Current US excess all-cause mortality is running around 10K above trend line on a good week. For these purposes we need neither know nor care if this is do to Covid directly, fear of catching Covid, or the effects of lockdown policies (e.g. increased rates of suicide from business failure).

Suppose we vaccinated the entire population. We would have to have a fatality rate of 1/32,000 to match a single week of the excess deaths the CDC is reporting every week.

Phase III, according to Moderna, is going to last around 4 months. If we skipped phase III and just jumped to phase IV, we could look to avert around 170,000 deaths with perfect effectiveness. Let’s say that between it being a lousy vaccine and people giving up on social distancing early we only save half of those lives. That gives us around 85,000 lives saved.

This means that we are looking at a 1/4,000 as our rough fatality rate for vaccines to be safer than waiting.

To date, I know of no vaccine that passed phase II clinical trials that has ever had this sort of fatality rate. Further, the vaccine adverse event rate is typically an order of magnitude or more higher than the fatality rate so absent truly astonishingly high rates of clinically significant adverse events it is highly unlikely to hit something greater than 1/4000 but not see some evidence of it with just a few hundred patients under your belt in the early phase trials.

My pre-test probability that any vaccine fall into a mortality rate somewhere between 1/100 and 1/4000 absolute risk increase is pretty low. So low, that all the papers I have read name them specifically rather than tabulating (e.g. Merck V710) and even those tend not to have dramatic increases in mortality (e.g. V710 had increased rates of Staph infections, but no increase in mortality).

Maybe something will be different this time and that will happen. Maybe we will be stuck with an inferior vaccine (though my guess is if we declared all of the top candidates ready for phase IV we could get a wide variety of use). But from where my point of view as I understand things from the coroner, we would need some massively high pre-test priors to make a dent in the weekly excess mortality rates.

For places that have been able to limit the virus’s entry (e.g. the island nations), this is all moot. For places that had massive initial spikes (e.g. Italy), this may also be moot. But for the US which flatten the initial curve and has maintained a steady excess death rate, early adoption seems to have very good Bayesian odds

You could of course make a QALY argument about Covid fatalities against vaccine fatalities, but again you are trying to hit a pretty narrow window: dangerous enough to beat down 10,000 excess deaths a weak, not so dangerous that it would have obviously failed early studies.

Challenge studies may have their place (e.g. ruling out antibody dependent enhancement), but we need to be sure that the immune response works in real world conditions. And at this point I still have terrible data for what actually happens during the course of the infection.

Inaction has one of the highest price tags we have ever seen in modern medicine. I just do not see any evidence that my pre-test priors for a vaccine being that deadly should be remotely high enough to make the math on delay work out (particularly if we can avoid the most susceptible patient populations for VAEs). Certainly my priors for the ability of social action to stop infections is far worse (e.g. HIV, Lyme, Scabies) so I am increasingly convinced that long term it is either a vaccine or the hard road to herd immunity.

CatintheHat addds:

I agree with this rough analysis and the risk is even less because we, probably only have to vaccinate 25 % of the population to stop the epidemic completely which could be done relatively quickly.

For the opposite case, don’t forget this earlier in August post of Alex’s.

I would very gladly run further estimates of this kind.  To be clear, I am not endorsing any particular conclusion, rather I think several hundred smart people should be working on this full time.  My personal suspicion is that the decisive factor will be “the gains from possibly ending a global depression a few months earlier” vs. “the risk that with a lower quality vaccine we don’t end said depression more effectively than we otherwise might have.”  And I hardly see anyone considering that trade-off at all.

There is also a closely related but conceptually separate question of how many vaccines to approve on an earlier basis, and also for how many should we be in a position to do so.

My dialogue with Freddie Sayers of Unherd, on herd immunity and related matters

It is about fifteen minutes, and also I give you all a separate clip of me praising the new Matt Yglesias book (which was alas cut from the main edit, note there is a lag before the short clip pops up) and discussing “family capacity libertarianism.”  Here is the main episode, with a few clips of text beneath the video itself:

Tyler Cowen on herd mentality and herd immunity

I was quite happy with how this interview turned out, and I feel a bit that I got to jab just about everybody, including the herd immunity theorists.

Brazil growing popularity of Bolsonaro fact of the day

As I have been saying, the median voter does not die of Covid-19, which means that many political responses will be highly imperfect.  Here is one recent narrative:

Some 66 million people, 30% of the population, have been getting 600 reais ($110) a month, making it the most ambitious social program ever undertaken in Brazil, a shocking shift under President Jair Bolsonaro who railed against welfare, dismissed the virus — and now finds himself newly popular.

The government hasn’t published its own figures yet but data from the Getulio Vargas Foundation, one of Brazil’s top universities, show that those living on less than $1.9 a day fell to 3.3% in June from 8% last year, and those below the poverty line were at 21.7% compared with 25.6%. Both represent 16-year lows.

Here is is more from Lima, Rosati, and Iglesias at Bloomberg.  By the way, Brazil’s primary deficit will be 11% this year.

Via Michael Pettengill.

Show your work, people — advice on vaccines and approval timing

Every day I read maybe twenty or more tweets decrying Trump’s acceleration of the FDA vaccine approval process.  And yet I do not see a single blog post with back of the envelope calculations.  This is such an important decision, and it deserves better, just as we analyze the Fed’s monetary policy decisions in great detail.  On those points, here is my latest Bloomberg column, excerpt:

One of your weaker arguments is that Trump’s push is disturbing because it is making the FDA “too political.” First, American responses to crises, such as Sept. 11 or the Great Recession, have always been political. Second, and more to the point, there is a strong case that the FDA should take politics into account more, not less.

The FDA has been too risk-averse in the very recent past, for instance in its reluctance to approve additional Covid-19 testing. Economists have generally concluded that the FDA is too risk-averse in the long term as well, considering all relevant trade-offs. What kind of fix might there be for those problems, if not a “political” one? Of course the initial risk-aversion was itself the result of a political calculation, namely the desire to avoid blame from the public and from Congress…

The American people will not buy the claim that the current [pre-Trump] FDA is above politics. Nor should they.

And:

As a public-health expert, you are also missing the broader context behind the current vaccine debate. In the early months of the pandemic, as late as April, it was common to hear that there might not be a vaccine for at least four years, and many were not sure if it would be possible at all. It is now likely (though not certain) that there will be a pretty good vaccine within a year.

That is a wonderful development, and it speaks well of your intelligence and hard work. Still, given that recent history, is it crazy for the American people to wonder if the process could be accelerated further? After all, the Chinese have a vaccine right now (albeit probably an inferior one), and they have been known to complete complicated infrastructure projects with a speed not previously thought possible.

And:

It’s not just about wanting to speed things up. One might argue that, due to the unprecedentedly high number of vaccines currently under consideration, the optimal threshold should be higher, not lower, for fear that the world will be left with a suboptimal choice.

Finally:

Too often I have seen one of you cite a single factor on one side of the approval equation, then invoke your authority or some previously existing institutional standard to suggest that this factor is decisive. In a Trumpian world, where credentials and authority no longer settle a debate — on public health or other matters — this kind of argument is not sufficient.

My plea is that such arguments and others be accompanied by concrete numbers, if only rough back-of-the-envelope estimates, and that all of the factors be considered together. Those numbers should incorporate the human, economic and public-health costs of allowing the current situation to continue for months. The result could be a useful public debate about the optimal speed of vaccine approval.

Yes, blah blah blah.  But — public health experts — show your work.

The Solomonic solution?

Or should that be “Solve for the equilibrium”?  How about “China Civil War of the Day”?:

The largest province in Solomon Islands has announced plans for an independence referendum as tensions with the country’s national government over China policy rise.

Malaita, a province of 200,000 people in the country’s east, “will soon conduct a provincial-wide referendum on the topic of independence”, a statement from premier Daniel Suidani said on Tuesday.

In a phone interview with the Guardian, Suidani confirmed the plan, saying a vote would be held as soon as this month.

The referendum plan comes after a year of tensions between Suidani’s provincial government, which is supportive of Taiwan, and Solomon Islands’ national government which has adopted a pro-Beijing stance.

Here is the full story.

*The Stakes: American at the Point of No Return*

That is the new book by Michael Anton, the famed then pseudonymous author of the “Flight 93 piece.”

I consider this to be the very best book for understanding where the current Intellectual Right “is at.”  In that sense I recommend it highly.  The opening chapter is a polemical fear that all of American will go the route of California, and then Anton keeps on digging further in on what has gone wrong.

To be clear, my vision is not the same as Michael’s.  I would like to see more emphasis on economic growth, on individual liberty, to recognize the emancipatory strands within the Left, to move away from the current historical pessimism of the Right and of Anton in particular, to be more unabashedly cosmopolitan, think more about science, and to become more Bayesian.  Nor do I agree that “…there’s little wrong with President Trump that more Trump couldn’t solve.”

Nonetheless this book serves a very valuable purpose and many of you should read it.

Why cancel culture will not take over everything

I was reading this blog post by Arnold Kling, and I thought I should put my own views into a Bloomberg column.  Here is one bit:

So what to make of the apparent growing strength of cancel culture and affiliated movements? Here is the fundamental point: With the rise of social media and low-cost communications, virtually everything that can be said, will be said.

It might be said on Twitter rather than on the evening news, or on 4Chan rather than on Facebook. But the sentiments will be out there, and many of them will be disturbing. The world has arrived at a place where just about every politically incorrect statement — and a response to it, not to mention every politically correct statement and a response to that — is published or recorded somewhere.

So the policing of speech may be vastly more common than it was, say, 15 years ago. But the discourse itself is vastly greater in scope. Political correctness has in fact run amok, but so then has everything else.

As a general principle, people notice what disturbs them more than what doesn’t. Therefore opponents of political correctness — and I include myself in this group — have a never-ending supply of anecdotes to be concerned about. I am not suggesting that this cycle will end well, but it does put the matter in perspective.

The issue is how social norms will adjust to cope with a world where everything is being said all the time. That path will not be smooth — but anxiety about it is different from fear of political correctness simply swallowing up everything and canceling everybody.

I’m no optimist. In fact, I suspect it will be harder to rein in the chaos and bewilderment from the say-whatever-you-want culture — have you checked out the pandemic discourse lately? — than to curb the intemperance of the you-can’t-say-that culture.

Consider also the evolution of internet communication. For all of its diversity, there are significant trends toward centralization. The English language is more focal than before, national politics command more attention than local politics, and the U.S. itself has more soft power in some crucial directions, thanks to its central role in the internet’s intellectual infrastructure. It is striking, for example, how much the entire world responded to the Black Lives Matter movement.

That means Americans will be subject to more cancellations and to more political correctness than people in the rest of the world. For better or worse, Americans are the central nexus that so many others are talking about, not always favorably. To quote Joseph Heller: Just because you’re paranoid doesn’t mean they aren’t after you — and Americans have good reason to be paranoid these days. If you published your politically incorrect column in your local Croatian newspaper, the rest of the internet just wouldn’t care all that much.

Yet note the underlying assumption here — namely, that American soft power is indeed growing. And if you are an American intellectual, your relative influence around the world is likely to be growing as well. With that greater influence comes greater scrutiny, and greater risk that you will be treated unfairly by the PC brigades. Is that really such a bad trade-off?

At first I was afraid that “all the wrong people” would like this piece, but so far so good.

Four stylized facts about Covid-19

We document four facts about the COVID-19 pandemic worldwide relevant for those studying the impact of non-pharmaceutical interventions (NPIs) on COVID-19 transmission. First: across all countries and U.S. states that we study, the growth rates of daily deaths from COVID-19 fell from a wide range of initially high levels to levels close to zero within 20-30 days after each region experienced 25 cumulative deaths. Second: after this initial period, growth rates of daily deaths have hovered around zero or below everywhere in the world. Third: the cross section standard deviation of growth rates of daily deaths across locations fell very rapidly in the first 10 days of the epidemic and has remained at a relatively low level since then. Fourth: when interpreted through a range of epidemiological models, these first three facts about the growth rate of COVID deaths imply that both the effective reproduction numbers and transmission rates of COVID-19 fell from widely dispersed initial levels and the effective reproduction number has hovered around one after the first 30 days of the epidemic virtually everywhere in the world. We argue that failing to account for these four stylized facts may result in overstating the importance of policy mandated NPIs for shaping the progression of this deadly pandemic.

That is the abstract of a new NBER paper by Andrew Atkeson, Karen Kopecky, and Tao Zha.  You will note that when it comes to Covid-19 cases, the superior performance Europe had enjoyed over the United States seems to be evaporating, see here on France and here on Europe more generally.

The quality-adjusted rate of price inflation is much higher than measured

Higher ed on Zoom, fear of going to the hospital, and long lines at the DMV bring us to one part of my latest Bloomberg column:

Education, health care and government are pretty big parts of our economy. If you add on the lower quality of restaurant visits, reduced sports performances (your ESPN cable package is worth less), and an inability to take preferred vacations and trips, you have many more negative quality adjustments that don’t show up in measured rates of inflation.

And:

The Bureau of Labor Statistics, the Bureau of Economic Analysis, the Fed and other institutions have declined to make formal adjustments for these changes in the real standard of living. That is the politically practical way to proceed, if not the technically correct decision.

Inflation measures work best when the consumption bundle is roughly stable over short periods of time, and that just hasn’t been the case this year. Because so many government payments depends on rates of indexation, debating “the true degree of inflation” this year would become an unending political football, with all the major institutions involved, including the Fed, losing credibility. (Just exactly how much worse is that Zoom lecture?) Besides, implicit price inflation from restricted opportunities probably should, for purposes of policy and benefits indexation, be treated differently than price inflation resulting from more expensive food and rent.

One implication is that, at least for the time being, price inflation rules just aren’t that meaningful any more:

…price rules and other forms of inflation rules don’t really work in times of pandemic. The very measurement of price inflation becomes arbitrary, and dependent on inertial measurement conventions from normal times, so the numbers don’t have enough actual economic meaning to guide policy.

There is more at the link.

Swiss Chinese markets in everything

Swiss authorities want to renew a discreet agreement with China, signed in 2015, which allows officials from Beijing to enter the country and question Chinese citizens residing here illegally…

The agreement allows Chinese officials to enter Switzerland for a period of two weeks – without official status – in order to investigate Chinese citizens found to be staying illegally in the Alpine Nation. Once identified, these people can be deported in collaboration with SEM.

Individuals affected by the agreement include rejected asylum seekers, illegal travellers, and those without identity papers.

And what exactly do the Swiss get in return?  Here is the full story, via Fergus McCullough.

The Black Lives Matter Plaza, WDC

Just north of the White House, I visited Sunday for the first time.  I am very much a fan of the “Black Lives Matter” block print letters as an artwork, and I wished to take in the broader social scene.  On the plaza I saw fully boarded up buildings for the Ronald Reagan Presidential Foundation and Institute, the AFL-CIO, and the Motion Picture Association of America, suitable victims it would seem.

On the Reagan building the sign reads “Fire Command Center.”

Downtown Washington D.C. will not be returning to its prior nature for some time to come.

The new marginal revolution

Sarah H., a 31-year-old woman in Philadelphia, feels that locking lips is the big risk, so “if you’re going to kiss someone, you might as well sleep with them.”

Here is the full article by Lisa Bonos, I had been wondering when a piece of this nature would appear.  This bit is also interesting:

Forman finds that the pre-date interrogation that happens in the era of covid-19 dating ratchets up all kinds of intimacy quickly. “Once the kiss happens … because you already went through all these other layers [of questions], you almost get to a fourth date know-how on a first date,” he says. “Even if it wasn’t going to turn into a girlfriend situation, we both just needed spontaneity that we hadn’t really had for months.”

Here is another sentence of interest and perhaps disputation:

He’s been careful during the past few months, but he’s still having casual sex when he feels comfortable.

I don’t expect we’ll ever have good data on the safety or danger of those practices.

Convalescent plasma?

Here is the FDA press release.  Here is StatNews coverage.  Scott Gottlieb tweets:

The available data seems to meet the bar for an EUA.

Here is his WSJ Op-Ed with McClellan, Straussian throughout I suspect.  They will only hint at their outrage at the process, noting that both are former FDA heads.  Here is the FDA truth twist.

I found this Adam Rogers Wired piece insightful and the best single treatment so far, and also interesting more generally on RCTs:

“Fifty thousand people have been given a treatment, and we cannot know whether it worked or not,” says Martin Landray, one of the leaders of the Randomised Evaluation of Covid-19 Therapies (or Recovery) Trial in England, a large-scale, multi-center, multi-drug randomized controlled trial that showed that the corticosteroid dexamethasone saved the lives of Covid-19 patients and the autoimmune drug hydroxychloroquine did not. (That 50,000 number was from a few weeks back, just after the plasma preprint came out.)

The main arguments against the decision from Trump/FDA seem to be “do RCTs” and “convalescent plasma isn’t shown to be so great.”  But those points have it exactly backwards.  Patients for trials are extremely scarce right now, and if convalescent plasma is not the highest probability big winner (and I suspect it isn’t), you won’t want to waste scarce patients on doing the RCT.  Moreover, if you can’t get the RCT done with 98,000 or so patients, maybe you’re just not up to doing it period!  (Please do think at the margin.)  In the meantime, convalescent plasma does not seem to involve harms or risks, and it may offer some benefits.  So why not let more people have easier access to it?

And might there be a tiny chance that American citizens demand stronger payment incentives for the relevant supplies here and also for other treatments?

If all people have is “do RCTs and CP isn’t shown to be so great,” I don’t think they have begun to engage with the arguments.  And additionally politicizing the FDA is definitely a real cost to be reckoned with, but the Twitter noise I am seeing from public health experts seems oblivious to the fact that the FDA’s ex ante risk-averse stance was politicized to begin with (which is not necessarily a bad thing, but yes this is a basic fact — “politicization for me, but not for thee,” etc.).