From the comments, on coronavirus and humidity

I am not convinced by the humidity hypothesis, as I don’t see it having much macro explanatory power globally, but I find the questions very important.  On New York City, I tend to blame all those cramped indoor spaces combined with bad ventilation systems, but that too is an unconfirmed hypothesis.  Anyway, here are the words of Daniel Hess:

Dear Tyler and Alex –

As you know the case fatality rate from COVID has been dropping dramatically from COVID. Many have suggested age profile and treatment advances are the cause urge you to consider indoor humidity as the biggest variable. It is *the* governing environmental variable for respiratory health, above all others and it is an accessible way for everyone to improve respiratory health. Urgently, CFR is likely to return in the fall and winter to its previously high levels unless this knowledge can be more widely disseminated.

The idea that the COVID death rate is dropping so rapidly primarily because of age or improvements in medicine does not explain why tropical and humid areas never had high death rates in the first place. Or why the CFR in the southeast was always lower than in the northeast, even before understanding of COVID improved.

Just look at these numbers (see table below) fresh from this morning from worldometers.info :

In Florida deaths/confirmed case is 0.015 but in New York it is 0.073. Is Florida medicine and age profile so much better than New York’s? Florida is a very old state and medicine is not regarded as more advanced in Florida than in New York. Both had to deal with COVID early and Florida’s age profile is particularly skewed old. In fact Florida is typically the retirement destination for aging New Yorkers.

In Mississippi deaths/confirmed case is 0.028 but in Massachusetts it is 0.072. Is Mississippi medicine and age profile so much better than Massachusetts’s? Mississippi is very poor and 40% black, and known to lag socioeconomically. Massachusetts is very wealthy and just 7% black, and known for its advanced medicine and socioeconomic success. If anything, you would expect a much higher CFR in Mississippi than in Massachusetts. But Massachusetts has cold winters, which translates into dry indoor air in the colder months.

In Georgia and Alabama, deaths/confirmed case are 0.019 and 0.017 respectively. In Michigan and Connecticut they are 0.069 and 0.088 respectively. Is Georgia so much younger and medically superior to Michigan? Is impoverished and 30% black Alabama so much younger and more medically advanced than wealthy Connecticut which is just 10% black? Of course not. You would expect Alabama to have a much higher CFR than Connecticut, but instead it is more than 5 times lower. This is an incredibly dramatic difference that is inexplicable until you realize that humidity (including indoor humidity) governs respiratory health to a very large extent.

It seems certain that seasonality plays a role, but more specifically indoor humidity. That is to say, where humidity seems to be most crucial is in reducing severity of symptoms and mortality for those already infected with COVID-19.

That was the finding of a group of 51 scientists in this new paper:

https://www.medrxiv.org/content/10.1101/2020.07.11.20147157v2.full.pdf

“Severity of COVID-19 in Europe decreased significantly between March and May and the seasonality of COVID-19 is the most likely explanation. Mucosal barrier and mucociliary clearance can significantly decrease viral load and disease progression, and their inactivation by low relative humidity of indoor air might significantly contribute to severity of the disease. ”

Innate respiratory immunity is impaired in conditions of low humidity, as has been shown extensively in this large review of the literature by a group led by renowned virologist Professor Akiko Iwasaki of Yale University. In fact, this may be the most comprehensive review of respiratory infection seasonality published anywhere:

https://www.annualreviews.org/doi/pdf/10.1146/annurev-virology-012420-022445

Folks, this is huge because it shows that a simple remedy (indoor humidification in temperate areas in winter months) can cut COVID-19 mortality by almost an order of magnitude.

Humidity as protection against respiratory infections is not new or surprising. Parents have been using humidifiers in nurseries for this reason for generations. Yet somehow, when it comes to COVID-19, all this knowledge is ignored. Madness!

Here is Alex’s source post, and there are a few interesting responses in the ensuing discussion.

Don’t mention the fake news

Even exposure to the ill-defined term “fake news” and claims about its prevalence can be harmful. In an experimental study among respondents from Mechanical Turk, Van Duyn, and Collier (2019) find that when people are exposed to tweets containing the term “fake news,” they become less able to discern real from fraudulent news stories. Similarly, Clayton et al. (2019) find that participants from Mechanical Turk who are exposed to a general warning about the prevalence of misleading information on social media then tend to rate headlines from both legitimate and untrustworthy news sources as less accurate, suggesting that the warning causes an indiscriminate form of skepticism.

That is from Brendah Nyhan’s good new JEP survey article on how misperceptions come about and persist.

Saturday assorted links

1. The polity that is Germany: “Light traps for insects are to be banned outdoors, while searchlights and sky spotlights would be outlawed from dusk to dawn for ten months of the year.’

2. The new Eisenhower  Memorial, by Frank Gehry, recommended, I am keen to see it.

3. Drive-in symphony concert.

4. Is the precautionary principle being applied to herd immunity claims?  And other interesting points on related matters.

5. Canadians taking revenge against visiting Americans (NYT).

6. Peptide antidotes, another promising treatment area.

7. Summary of the UK planning changes.

Bill Gates is Angry

But people aren’t getting their tests back quickly enough.

Well, that’s just stupidity. The majority of all US tests are completely garbage, wasted. If you don’t care how late the date is and you reimburse at the same level, of course they’re going to take every customer. Because they are making ridiculous money, and it’s mostly rich people that are getting access to that. You have to have the reimbursement system pay a little bit extra for 24 hours, pay the normal fee for 48 hours, and pay nothing [if it isn’t done by then]. And they will fix it overnight.

Gates is correct. If companies were paid for speed they would increase capacity and move immediately to a stack processing (LIFO) model, as I described yesterday.

The whole interview is worth reading. Gates is restrained but you can tell he is angry. Bill has had it with the FDA, Trump, Mark Zukerberg, stupid anti-vaxxers like Robert Kennedy (who he was forced to listen to to get access to Trump), Congress and much more. I don’t blame him one bit. I am angry too.

Beware of coronavirus moralizing

That is the topic of my latest Bloomberg column, here is one excerpt:

Then there is the Swedish experiment, which has been the subject of a raging controversy. Here again, most moralizing is premature, even though the Swedes did make some clear mistakes, such as not protecting their nursing homes well enough. Sweden had a high level of early deaths, but both cases and deaths have since fallen to a very low level, even though Sweden never locked down. In the meantime, the Swedish economy has been among the least badly hit in Europe.

If the rest of Europe is badly hit by a second or third wave, and Sweden is not, Swedish policy suddenly will look much better. Alternatively, if Sweden experiences a second wave of infections as big as or bigger than those of its neighbors, it will look far worse.

In other words, it is too soon to tell.  I love to moralize about the moralizers!  Which I do more of at the link.

Are pre-docs in economics a good idea?

Formal pre-doc programmes have burgeoned, especially in elite universities such as Harvard, Stanford, the University of Chicago and Yale. Participants clean and analyse data, write papers and do administrative tasks. In exchange they may receive free or subsidised classes, a salary in the region of $50,000, potential co-authorship of the papers they work on, and, most prized of all, a letter of recommendation to a top programme.

In part pre-docs show how economic research has changed. “Economics has become more like the sciences in terms of both the methods and the production process,” says Raj Chetty of Harvard, who directs the Opportunity Insights team, a group with a reputation for working its pre-docs hard. When analysing tax records that gave access only to a certain number of people, he switched away from using part-time research assistants to a lab-like team, inspired by his own family of scientists. As bigger data sets, new techniques and generous funding made such collaboration worthwhile, others followed.

Here is much more on pre-docs from Soumaya Keynes at The Economist.  I suspect this development is inevitable, but I see at least two things going on here.  First, letter writers are internalizing the very high value of those letters in the form of personal services received.  Second, this will push out “weirdos” and make the profession more homogenized, more obedient, more elite, more dependent on school of origin, and less interesting.  I do understand the value of the training received, and don’t propose any mechanism to “stop this,” but overall it does not make me an entirely happy camper.

Ideas Of India

Ideas Of India is Shruti Rajagopalan’s new podcast about India. This is going to be an excellent podcast, well worth subscribing to. Shruti’s first guest is Ajay Shah discussing his book with Vijay Kelkar, In Service of the Republic: The Art and Science of Economic Policy. As you may recall, I called In Service, the new Arthashastra, the book every policy maker and future policy maker should be given while being told, “before you do anything, read this!”

Here’s one bit from Ajay in the podcast:

[S]tate capacity is very hard to change. It evolved very slowly, but it is something you learn. There’s a learning by doing for a republic to learn to achieve state capacity. So we would tell a more constructive story of saying,” Pick a few battles, do a few things, learn how to do them well.” Then maybe in the future you might like to creep out, while understanding that these are 20-year, 40-year, 80-year, hundred-year journeys. Don’t think that these things can be solved in two years.

…There’s a quote in the book from Kaushik Basu where he said that we have libertarianism of necessity, and we have libertarianism of choice. In India, we have to do libertarianism of necessity because we every day confront the malfunctioning state institutions. We’ve always got to think, can this work? Would it go wrong? We’re surrounded by unchecked coercive power in the hands of very frail state institutions, and that creates limits on state capacity. So I think that’s the way our lived experience in India has brought us.

Exactly right and very consistent with the argument that Rajagopalan and I make in Premature Imitation and India’s Flailing State:

In the alternative view put forward here…presumptive laissez-faire is the optimal form of government for states with limited capacity and also the optimal learning environment for states to grow capacity.

Much more of interest. You can (and should!) subscribe to the podcast on Apple, Spotify, Google, or the podcast app of your choice.

Stack-Push-Pop COVID Testing

A COVID test that doesn’t come back in a few days is close to useless and PCR tests are taking a long time to process:

NYTimes: Most people who are tested for the virus do not receive results within the 24 to 48 hours recommended by public health experts to effectively stall the virus’s spread and quickly conduct contact tracing, according to a new national survey by researchers from Harvard University, Northeastern University, Northwestern University and Rutgers University….People who had been tested for the virus in July reported an average wait time of about four days. That is about the same wait time for those who reported taking a test in April. Over all, about 10 percent of people reported waiting 10 days or more.

…“A test result that comes back in seven or eight days is worthless for everybody — it shouldn’t even be counted,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security and a physician in Pittsburgh. “It’s not a test in any kind of effective manner because it’s not actionable.”

One seemingly severe but potential solution is to change how tests are processed. Right now it’s mostly first come, first-served but this means we can easily have a situation where everyone eventually gets a test result but all the results are useless because they take a week or more to process. I propose instead that any test that can’t be reported back in 3-4 days be thrown out immediately. Labs should focus only on processing tests that can be reported back quickly.

One way of thinking about this is to use a stack or last-in first-out (LIFO) model for testing. In a stack model the newest test request is pushed onto the top of the stack and the next test to be processed is popped off the top of the stack. One disadvantage of this model is that some test requests will never be processed (they should be removed from the bottom of the stack and returned as null results). Some people will be angry.

But the stack model of testing has a huge advantage over first-come, first-served. Namely, just as many tests will be completed as under the current model but the tests results will all come back faster and be much more useful. What would you rather have, guaranteed stale test results or fresh results with some possibility of a null return? Since a stale result is not much better than a null it seems obvious that the stack system is superior. Most importantly, faster, more useful tests will help to end the crisis by reducing the number of infections.

Addendum: See also my posts Pooled Testing is Super-Beneficial and Frequent, Fast, and Cheap is Better than Sensitive on other methods to improve testing.

What I’ve been reading

My local public library has reopened!  From the library and from elsewhere, I have been enjoying:

1. Orlando Figes, The Europeans: Three Lives and the Making of a Cosmopolitan Culture.  The three lives are Turgenev, his mistress Pauline Viardot, and the husband of his mistress, Louis Viardot, a noted financier and activist.  Consistently interesting, even if you are not looking to read about those three particular figures.

2. John Dickie, The Craft: How the Freemasons Made the Modern World.  Although it has a stereotypically bad subtitle, this is an excellent book.  It clarifies exactly where the Freemasons came from (dissident thought connected to James II), its connection to actual masons, how the movement got routed through Scotland, its prominence to the Enlightenment, its African-American component (Martin Delany), how it influenced Joseph Smith and Mormonism, why Castro tolerated it and the Shah of Iran encouraged it, and much more.  Not in the book, but did you know that the Freemasons claim Shaquille O’NealShaq confirms.

3. Callum Williams, The Classical School: The Turbulent Birth of Economics in Twenty Extraordinary Lives.  A clear, well-written, and useful introduction to the lives and thought of some of the leading classical economists.  The “unusual picks,” by the way, are Harriet Martineau, Rosa Luxemburg, and Dadabhai Naoroji.  The author is a senior economics writer for The Economist.

4. Michael Hunter, The Decline of Magic: Britain in the Enlightenment.  “Though it is often thought that the scientists of the early Royal Society tested magic and found it wanting, this is a misconception.  In fact, the society avoided the issue because its members’ views on the subject were so divided, and it was only in retrospect that this silence was interpreted as judgmental.”

Forthcoming from Marc Levinson, the author of The Box, is a new book Outside the Box: How Globalization Changed from Moving Stuff to Spreading Ideas, a more general history of globalization.

The YIMBYs win one, in the UK

The government is determined all the same, in keeping with the prime minister’s desire to “build, build, build”, to loosen our restrictive planning system. His proposed reforms will curb the ability of local politicians to slow down plans that have received initial approval. The requirements for developers to include cheaper housing on their sites will be relaxed. Land will be split into the three categories of growth, renewal, and preservation. Any school, shop or office which meets local design standards will be given an assumed permission to develop in the first two of these three categories. The aim will be for each area to agree a local plan in 30 months rather than the current average of seven years.

Here is more from Phillip Collins at the London Times (gated).  Do any of you know of a good ungated link on this?  Here is The Guardian, in unsurprising fashion, siding with NIMBY.  So far the BBC just doesn’t seem that interested.  Anywhere else to look?

Addendum: From Conor, here are some links:

–          Via CapX, which is a great aggregator plus original commentary: https://capx.co/these-profound-reforms-offer-a-chance-to-build-more-and-build-more-beautifully/

–          Via Conservative Home, here is the housing lead at Policy Exchange: https://www.conservativehome.com/platform/2020/08/ben-southwood-yes-the-current-planning-system-really-is-at-the-root-of-britains-housing-crisis.html

–          Twitter thread from Adam Smith Institute’s Matthew Lesh: https://twitter.com/matthewlesh/status/1291368548590379008

–          A summary and link to the full report itself: https://www.gov.uk/government/news/launch-of-planning-for-the-future-consultation-to-reform-the-planning-system

And longer reads, here are a couple of policy papers from the past that helped inform this report:

–          Policy Exchange paper: https://policyexchange.org.uk/wp-content/uploads/Rethinking-the-Planning-System-for-the-21st-Century.pdf

–          The Roger Scruton chaired Building Better, Building Beautiful Commission: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/861832/Living_with_beauty_BBBBC_report.pdf

Thursday assorted links

Is Early Vaccination a Good Idea?

On August 2, bio-statistician Steven Salzberg argued that We Should Consider Starting Covid-19 Vaccinations Now. But, under immense pushback, including an article by another bio-statistician Natalie Dean writing in the NYTimes, he changed his mind and reversed course. I was frustrated by both sides of the debate since neither “biostatistician” presented any numbers to justify their arguments! So let’s do this better.

Suppose you take a vaccine now as opposed to (optimistically) on Dec. 1, 2020. From May 1 to August 5 we averaged 1001 deaths a day. There are 117 days between now and Dec 1 so at that rate there will be ~117,000 additional deaths by Dec. 1. Let’s call it 100,000. There are 324 million people living in the United States so the probability of dying from COVID in the next 117 days is 1/3240 or .03%.

Now what are the risks of dying from a vaccine? We don’t know these risks but suppose the vaccine is given to 100 million people in the United States then in order for there to be an equal number of deaths the probability of death from the vaccine would have to be 1/1000. That’s unlikely but not impossible!

Furthermore, phase three trials are the acid test for efficacy. Results from many phase II trials look good but we will learn more in a larger, more varied population actually at risk for the disease. We will also will learn which vaccines are better, e.g. Novavax’s protein based vaccine looks much better than others in early trials and that will become clearer with larger trials.

Overall, the numbers here do not make a strong case for vaccinating early. I’ve long argued that the FDA is much too risk averse in approving new drugs but vaccines are meant to be given to large numbers of healthy people which makes risk aversion more reasonable.

Note, however, that these numbers are for a randomly chosen member of the population but the people choosing to vaccinate early will not be randomly chosen. If you are an African-American or Latino, for example, your risks are higher. Your risks are higher still if you are an older, male, African-American or Latino physician, nurse, taxi driver or nursing home resident. In these cases, my judgment is that the benefits swing towards early vaccination. The benefits would be larger still if we assume that a vaccine won’t be available until 2021.

I’ve focused on deaths. Clearly, there are also other health risks but they fall on both sides of the equation.

A mass vaccination campaign in advance of phase three clinical trials would be unwarranted. Vaccinating large numbers of healthy people has real risks. Nevertheless, in my view it would not be unreasonable for someone at high-risk of COVID to choose to be vaccinated before waiting for longer clinical trials and such early vaccination, as Tyler noted, would also provide valuable information for everyone else.

Addendum: The Open Source RADVAC vaccine is one option for those with the requisite medical expertise.

What did the China hawks get right and wrong about China?

That is the topic of my latest Bloomberg column, here is part of the closing bit:

Where does all this leave U.S. China policy? As a rule of thumb: If it is of clear and limited scope and can be conducted technocratically, and can avoid both excess media coverage and political polarization — and, crucially, if it requires no obvious sacrifices from American citizens — then a policy stands a pretty good chance of succeeding. But that is not enough to justify a new global crusade. Over the last year or so, no matter what you might think of the government in Beijing, it has become clear that the government in Washington faces some real limits in responding to it.

I would stress that predictively, in their analysis of China, the hawks got almost everything right and the accommodationists got almost everything wrong.  There is just not so much we can do about that…

The Flynn Effect is stronger than you think

Despite the lack of effective treatments or preventive strategies, the dementia epidemic is on the wane in the United States and Europe, scientists reported on Monday.

The risk for a person to develop dementia over a lifetime is now 13 percent lower than it was in 2010. Incidence rates at every age have steadily declined over the past quarter-century. If the trend continues, the paper’s authors note, there will be 15 million fewer people in Europe and the United States with dementia than there are now…

Researchers at Harvard University in Cambridge, Mass., reviewed data from seven large studies with a total of 49,202 individuals. The studies followed men and women aged 65 and older for at least 15 years, and included in-person exams and, in many cases, genetic data, brain scans and information on participants’ risk factors for cardiovascular disease.

The data also include a separate assessment of Alzheimer’s disease. Its incidence, too, has steadily fallen, at a rate of 16 percent per decade, the researchers found. Their study was published in the journal Neurology.

In 1995, a 75-year-old man had about a 25 percent chance of developing dementia in his remaining lifetime. Now that man’s chance declined to 18 percent, said Dr. Albert Hofman, chairman of the department of epidemiology at the Harvard School of Public Health and the lead author of the new paper.

Interestingly, this decline seems to be confined to Europe and the United States.  Here is the Gina Kolata piece in the NYT.