Category: Medicine

Externalities and Covid

I am getting a little ornery with all of the people citing Covid externalities, and then not going a step deeper.  To be clear, I agree we should subsidize preventive measures (most of all vaccines and testing, but more too), and close down high-risk indoor gatherings in many locales.  No more Democratic Party fundraisers in New York State, not indoors at least.

What is being neglected is that many of the American people are voting with their feet when it comes to externalities, and we may not always like the answers we are seeing.  Take all of the pending Thanksgiving travel — the biggest risk is to parents and grandparents, but mostly they are receiving their children voluntarily.  Now I get that there is a higher-order risk to friends of the parents and grandparents, and that externality is not internalized, but still…much of the externality is in fact internalized.

I haven’t seen many (any?) jurisdictions in this country where the median voter wants to shut down Thanksgiving travel.  Do please note it is in fact my personal preference that no one travel for Thanksgiving, but I’m not going to confuse that preference with the Coasean outcome or for that matter the democratic outcome.  It might be the Coasean outcome in northern Jutland, it does not seem to be here.

Or consider mobility.  The people of means I know have been moving to Austin and Miami, two locales that are both quite open in the sense of having relatively few Covid-related restrictions on commerce.  These individuals do not have to work as a cashier in the Safeway, and so they can enjoy the openness while avoiding most of the corresponding risk.  They can work at home and socialize outside.  Maybe the weather, the time zone, the “coolness” of the locale, and other factors are more important than the stores being open.  Still, the “loose” Covid policies have not scared them away.

One might expect that front-line workers would be less keen to move to Austin and Miami, but I have not seen data to that effect and I am not convinced that is true on net.  I genuinely would like to know, and in the meantime am agnostic on the question.

I don’t see many people moving into Vermont or San Francisco, two locales that have done a good job minimizing Covid risk.

Analytically, you might put it this way.  There always have been positive externalities from human contact through commerce, and at the margin, even with Covid risk, for many people those externalities still are positive.  Thus if you limit or tax those interactions, the policies will be unpopular.

I genuinely do think many of our failings are those of prudence rather than externalities.  That is one reason why I am reluctant to recommend large-scale coercive lockdowns, while still regarding the positive fight against Covid with extreme urgency.  Three of our prudence failings are the following:

1. We are not good at intertemporal substitution in this context, and

2. The risks of Covid are sufficiently stressful that many people instead prefer to self-deceive and minimize the risks, rather than deal with the stress (NB: this is one instance where higher stakes and decisive choice lead to a worse rather than a better outcome, contra Caplan).

3. Many individuals are bad at grasping the multi-week reporting lags and also the “Blitzkrieg” nature of the struggle.

I am reluctant to smush together the externalities argument and the paternalism argument for policy activism, and instead prefer to unpack the two, even though that weakens the case for major restrictions.  It disturbs me that few public health commentators or for that matter commenting economists are willing to consider even this simple analytic division.  Talking about all the deaths does not in fact settle the matter, as it remains necessary to ask what Americans really want, and how much we ought to be willing to respect those preferences.

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.

The political economy of Swine flu vaccine allocation

Previous research has isolated the effect of “congressional dominance” in explaining bureaucracy-related outcomes. This analysis extends the concept of congressional dominance to the allocation of H1N1, or swine flu, vaccine doses. States with Democratic United States Representatives on the relevant House oversight committee received roughly 60,000 additional doses per legislator during the initial allocation period, though this political advantage dissipated after the first 3 weeks of vaccine distribution. As a result political factors played a role in determining vaccine allocation only when the vaccine was in particularly short supply. At-risk groups identified by the Centers for Disease Control (CDC), such as younger age groups and first responders, do not receive more vaccine doses, and in fact receive slightly fewer units of vaccine.

That is from an Economic Inquiry paper by Matt E. Ryan.  Via Henry Thompson.

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.

More immigrant founders and co-founders, in this case Moderna

Noubar Afeyan, co-founder and chairman of Moderna, is a two-time immigrant. He was born to Armenian parents in Lebanon and immigrated with his family in his early teens to Canada. After attending college, Afeyan came to the United States and earned a Ph.D. in biochemical engineering at the Massachusetts Institute of Technology (MIT). He started his first company at age 24 and ran it for 10 years, during which time he founded or co-founded five additional companies.

…Moderna’s CEO is Stéphane Bancel, who immigrated to America from France. He earned a master of engineering degree from École Centrale Paris (ECP), and came to the United States as an international student, receiving a master of science in chemical engineering from the University of Minnesota and an M.B.A. from Harvard Business School.

Here is the story, there will be more like it…

Intertemporal substitution remains underrated (Covid in Scotland)

He suggested the announcement that the roll-out of a vaccine within weeks had persuaded people to break the rules and take risks.

“People maybe think the battle is over because the vaccine is coming…”

Here is the Times of London story.  Of course economics suggests the exact opposite course of action, namely that when a good vaccine is coming you should play it safer in the meantime.  Beware!

Economics and epidemiology, revisited

The Economist was kind enough to reference my earlier blog post on this topic, from April 12, so I thought we should look at it again.  Please do reread it!  Here are my first two points:

1. They [epidemiologists] do not sufficiently grasp that long-run elasticities of adjustment are more powerful than short-run elasticites.  In the short run you socially distance, but in the long run you learn which methods of social distance protect you the most.  Or you move from doing “half home delivery of food” to “full home delivery of food” once you get that extra credit card or learn the best sites.  In this regard the epidemiological models end up being too pessimistic, and it seems that “the natural disaster economist complaints about the epidemiologists” (yes there is such a thing) are largely correct on this count.  On this question economic models really do better, though not the models of everybody.

2. They do not sufficiently incorporate public choice considerations.  An epidemic path, for instance, may be politically infeasible, which leads to adjustments along the way, and very often those adjustments are stupid policy moves from impatient politicians.  This is not built into the models I am seeing, nor are such factors built into most economic macro models, even though there is a large independent branch of public choice research.  It is hard to integrate.  Still, it means that epidemiological models will be too optimistic, rather than too pessimistic as in #1.  Epidemiologists might protest that it is not the purpose of their science or models to incorporate politics, but these factors are relevant for prediction, and if you try to wash your hands of them (no pun intended) you will be wrong a lot.


I have not yet seen a Straussian dimension in the models, though you might argue many epidemiologists are “naive Straussian” in their public rhetoric, saying what is good for us rather than telling the whole truth.

Many people took umbrage at my points, but:

On this list, I think my #1 comes closest to being an actual criticism, the other points are more like observations about doing science in a messy, imperfect world.

I also queried about the political orientation of epidemiologists (among other matters), and that occasioned a great deal of pushback and outrage. Yet we saw during the summer that many of them were explicitly political and favoring the Left, willing to abandon their earlier recommendations to endorse demonstrations for a cause they strongly favored.  I am not sure how big was the resulting boost in cases or fatalities, but it did seem the American people concluded that you could ignore the rules if something was sufficiently important to you.  Like visiting your relatives for Thanksgiving, and we will be reaping that harvest rather soon.

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.

How do the NIH and NSF work?

A surprising number of individuals responded to my post last week soliciting books about the NIH and NSF.  Thank you to those who did and please do still feel free to reach out on this matter.

It became apparent that a highly complementary effort would be a Substack/blog/podcast/similar about the inner workings of the NIH / NSF, and indeed other institutions relevant to the modern-day administration and practice of science.  Think SCOTUSblog or Macro Musings, but focused on the NIH/NSF/etc.

So, if you would like to start such a blog/podcast/newsletter, please email me, and that plan will be considered for financial support.

Free Britney Spears

Jamie Spears was authorized by the California Superior Court to control his daughter’s finances, health care, and aspects of her daily routine. The conservatorship was initially temporary. Twelve years later, it’s still in place. The court documents and hearings—there have been many over the years—have been mostly sealed to the public, so little is known about the actual nature and conditions of the agreement.

Britney’s father can control virtually all of the terms of her life, and Britney is vociferously opposed to having him as her “conservator.”  I know very little about the mental condition of Britney Spears, but I would think the case for enslaving her — as we have done — should face a very high bar indeed.  She hardly seems totally unable to function:

She released four albums, went on as many world tours and, for her successful Piece of Me residency in Las Vegas, played 248 shows in the span of four years, grossing $500,000 per show.

Guess who controls the money and the terms of employment?  The Straussian element shows up on Instagram:

What appears to the uninitiated as a random assortment of selfies, inspirational quotes, and dance videos is, according to supporters of the so-called #FreeBritney movement, a desperate plea for help. First, there was the color of her shirt, which appeared to match commenters’ calls for her to wear yellow (or red, or blue, or white, or anything) if she were in trouble. Then there were the roses, “a symbol of secrecy and silence,” as one user pointed out. In one video, Spears walks back and forth nine times, obviously Morse code for SOS. And then of course there were her eyelashes.

Here is the full article from Vanity Fair. Don’t forget this:

“Conservatorships are very hard to get out of—much, much harder to get out of than to get into, and that’s something many people don’t realize, even people who are seeking conservatorships,” said Zoe Brennan-Krohn, a staff attorney with the ACLU’s Disability Rights Project.

Britney’s life matters, free Britney Spears.

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.