Category: Current Affairs
The death curve is going vertical
Via Eric Topol.
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.
Right-thinking Henry Olsen on Trump voter fraud
None of these early warning signs of fraud appear in the results.
There is much more detail and argument at the link. Via Ross Douthat.
Predictions of the herd immunity theorists
If you are still pondering the Great Barrington Declaration and related matters, let us try a simple empirical test about predictions. Start with this from one of the authors of the Declaration:
…the professor of theoretical epidemiology at Oxford University, Sunetra Gupta. In May she declared: “I think that the epidemic has largely come and is on the way out in this country.”
Link here. The UK just hit 500 deaths a day, highest since May and about 2x the current U.S. rate.
She also said:
“So I think the [infection fatality rate, or IFR] would be definitely less than one in 1,000 and probably closer to 1 in 10,000. That would be somewhere between 0.1% and 0.01%.”
Dominic Lawson continues:
As Sam Bowman, of the free-market Adam Smith Institute — and therefore far from an illiberal interventionist — observed: “By this point, 36,000 had died of Covid in the UK. If 100% of the UK’s population had had Covid by then, the UK would have had to have a population of 360 million people for her low-end IFR to be right.”
Or why not read that august institution The Otago Times?:
Sweden’s former top virus expert says lockdowns are just a way of delaying the inevitable and warns that New Zealand could face years of quarantining foreigners entering the country, even after wiping out Covid-19.
Johan Giesecke has defended his country’s coronavirus strategy, saying lockdowns do not prevent surges in cases or deaths, but merely delay them.
Giesecke believes it is “futile” to attempt to stop the spread and says most countries will end up in a similar position, regardless of their strategy, until treatment can be found.
He believes Denmark, Norway and Finland, which are in full lockdown, will end up with the same number of cases as Sweden, which isn’t, as soon as their restrictions ease.
He also says New Zealand will begin importing cases from overseas, after successfully suppressing the virus during lockdown.
To avoid that, quarantine measures will have to stay in place until a vaccine is developed – something he says could take a decade, or longer.
Come on people, you were wrong. By the way, “Covid-19 hospitalizations in the United States hit an all-time high of 61,964 on Tuesday,” and deaths running about 1,300 a day. Not a nothingburger. p.s. One in five survivors end up diagnosed with a mental illness.
The first global election?
That is the topic of my latest Bloomberg column, here is the closing bit:
What kind of bargain is it for the country for the U.S. election to be the object of such global interest? We Americans may be flattered by the attention, but it is not clear that it is such a good thing. For one thing, it gives foreigners a greater incentive to try to manipulate U.S. elections.
Another possible problem is that political coalitions will, over time, be defined globally rather than nationally and locally. Is your presidential candidate attracting support from the wrong factions in France, Germany or South Sudan? On one hand that could be useful information, but it could also prove misleading. Foreigners support U.S. presidential candidates for their own reasons, and it could be distorting to have so many outside parties involved. That’s what happened in the Brexit debates, in which a pro-Brexit position was (and remains) all too quickly identified with populism, anti-globalization and support for Trump. The Brexit debate might have been more sane if it had been more local.
What if, come the next U.S. presidential election, most of the social media debate is among non-Americans? What if much of the world ends up with a common, one-dimensional political spectrum, rather than each country having its own (mostly) independent politics? We may be about to find out.
I’ll say it again: American soft power is rising, not falling.
Where We Stand
There is good news and there is bad news.
Let’s start with the good news.The early results from the Pfizer vaccine are very good, 90% efficacy. That will probably fall a bit but it’s very good news not just for the Pfizer vaccine but for most of the vaccines in the pipeline which target the spike protein.
The Pfizer vaccine does require very cold storage which means it won’t work for large parts of the world. A distribution plan is in place for most of the United States and Pfizer already has 50 million doses, which can cover ~25 million people, in storage.
Many thousands of people are dying every week so Pfizer should apply for and the FDA should issue a EUA without further delay.
One issue is, given limited supply, how to distribute the vaccine. I have suggested we randomize distribution across hospitals, police and fire stations, and nursing homes (see also my piece in Bloomberg with Scott Kominers, The Case for a COVID Vaccine Lottery.) A vaccine lottery is fair, it will make distribution easier by limiting the number of vaccination locations and it will in essence create a very large clinical trial. With millions of participants we will be better able to make fine distinctions between the vaccine’s safety and efficacy in different populations and the results will come in quickly. Thus, if we randomize and collect data, limited capacity has a silver lining.
Second issue. Manufacturing capacity. Pfizer will have enough capacity to produce 1.3 billion doses in 2021 which sounds like a lot but it’s a two dose vaccine and there will be losses in distribution so maybe 500 million people vaccinated. We need to vaccinate billions.
The cost to the world economy of COVID is in the trillions so we want to vaccine a lot faster. Faster than private markets are willing to go. There are other vaccines in the pipeline but we still need to ramp up capacity. Increasing capacity is something that Michael Kremer, Susan Athey, myself and others at Accelerating Health Technologies have been working on since the beginning of the crisis. It’s not too late to do more.
Third issue is testing. Trump got it into his head that more tests means more cases when in fact a lot more tests means fewer cases. There is a Laffer curve for testing. Our failure to get ahead of the virus with tests has meant hundreds of thousands of excess deaths. We are still failing this test. Winter is coming. Infections and deaths are both rising.
Biden won’t be president until late January but there are things he can do now. In particular, Congress already allocated $25 billion to testing in April—that was far too little. We spent trillions on relief and comparatively little fighting the virus. But here is the real shocker, most of the $25 billion allocated in April hasn’t been spent. Let me say that again, most of the money allocated for testing in April has not been spent. Biden can signal today that that money and more will be spent. He can also signal, as in fact he has, that he wants rapid antigen tests approved.
Rapid antigen tests are cheap, paper strip tests that can check for infectiousness and are ideal to getting things like the schools running again.
Even if we start vaccinating this year, we won’t vaccinate a majority of the US population until well into 2021. That’s true but what’s underappreciated is that testing, masks, social distancing and vaccines are complementary. The more people are vaccinated, for example, the greater our testing capacity rises relative to the population at risk.
The pandemic is getting worse not better but we did flatten the curve, albeit imperfectly, and now if we can summon the will, we have the tools including rapid antigen tests, vaccines and monoclonal antibodies to really crush the virus.