Results for “cohort” 216 found
New Emergent Ventures anti-Covid prize winners
The first new prize is to Anup Malani of the University of Chicago, with his team, for their serological research in India and Mumbia. They showed rates of 57 percent seroprevalance in the Mumbai slums, a critical piece of information for future India policymaking. Here is the research.
Professor Malani is now working in conjunction with Development Data Lab to extend the results by studying other parts of India.
The second new prize goes to 1Day Sooner, a 2020-initiated non-profit which has promoted the idea of Human Challenge Trials for vaccines and other biomedical treatments. Alex here covers the pending HCTs in Britain, as well as providing links to previous MR coverage of the topic.
I am delighted to have them both as Emergent Ventures prize winners.
Here are the first, second, and third cohorts of winners of Emergent Ventures prizes against Covid-19.
The Distribution of Vaccines in the 19th Century
Distributing a COVID vaccine to billions of people will be challenging. We will require vials, needles, cold storage, air travel, trained health care professionals and much more. The challenge of distributing a smallpox vaccine in the 19th century was even greater because aside from fewer resources the vaccine, cowpox, was geographically rare and infected humans only with difficulty. Moreover, the best method of storing the vaccine was in a person but that worked only until the person’s immune system defeated the virus. Thus, a relay-race of vaccine couriers was created to distribute the vaccine around the world.
In 1803, the [Spanish] king, convinced of the benefits of the vaccine, ordered his personal physician Francis Xavier de Balmis, to deliver it to the Spanish dominions in North and South America. To maintain the vaccine in an available state during the voyage, the physician recruited 22 young boys who had never had cowpox or smallpox before, aged three to nine years, from the orphanages of Spain. During the trip across the Atlantic, de Balmis vaccinated the orphans in a living chain. Two children were vaccinated immediately before departure, and when cowpox pustules had appeared on their arms, material from these lesions was used to vaccinate two more children.
The British tried the same thing to get the vaccine to India but heat and shipwrecks led to many failures until, as Andrea Rusnock writes, Jean De Carro successfully delivered live cowpox to Bombay from Vienna via Baghdad.
De Carro, a Genevan who had received his M.D. from Edinburgh and who practiced medicine in Vienna, became one of the staunchest supporters of Jenner on the continent. It was through De Carro’s effort that vaccination was introduced in Austria, Poland, Greece, and the cities of Venice and Constantinople. In a letter to Jenner, De Carro carefully described his successful shipping technique. First he saturated lint with cowpox lymph and then placed the lint between two pieces of glass, one concave, one flat. He then sealed it with oil. “To prevent the access of light,” De Carro continued, “I commonly fold it in a black paper, and when I was desired to send to Baghdad, I took the precaution of going to a wax-chandler’s, and surrounded the sealed-up glasses with so much wax as to make balls. With this careful manner it arrived still fluid on the banks of the Tigris.
In the United States, Thomas Jefferson also wanted to be vaccinated but after several failures to deliver live cowpox from the Harvard Medical School, “Jefferson designed a new container: An inner chamber would hold the fluid lymph, while a surrounding chamber, filled with cool water, insulated the lymph.”
[Later] President Thomas Jefferson gave some cow lymph to Meriwether Lewis and William Clark to take on their explorations west of the Mississippi River. Antoine Saugrain, the only practicing physician in St. Louis when Louisiana was purchased by the United States from France in 1803, received some cowpox lymph from Lewis and Clark and began to vaccinate individuals free of charge, including Native Americans. Saugrain’s free vaccination program established cowpox in the Mississippi valley roughly a decade after Jenner published his inquiry.
Talk about Operation Warp Speed!
Even when delivered, the vaccine had to be kept alive so each cohort of vaccinators was incentivized to provide the vaccine for the next cohort:
In Glasgow, parents had to put down a deposit of 1 shilling (1801) and later 2 shillings (1806) to be refunded only when the child was returned to the clinic [and more cowpox could then be extracted from the children’s lesions]. In Boston, Waterhouse resorted to paying parents to vaccinate their children in order to keep a supply of cowpox.
Occasionally, herd immunity would be reached but that meant there was no way to store the vaccine for the next generation! Physicians, therefore, looked to newly created institutes that shipped the vaccine by one method or another around the world.
Returning to the British and India, after cowpox was delivered through De Carro’s efforts to Baghdad an Armenian child was infected and lymph from his arm was taken to Basra where an East India Company surgeon established a an arm-to-arm relay race that brought cowpox to Bombay:
On 14 June, 1802, Anna Dusthall became the first person in India to be successfully vaccinated against smallpox. Little else is known about her, except that she was “remarkably good tempered”, according to the notes of the doctor who vaccinated her…The following week, five other children in Bombay were vaccinated with pus from Dusthall’s arm. From there, the vaccine travelled, most often arm-to-arm, across India to various British bases – Hyderabad, Cochin, Tellicherry, Chingleput, Madras and eventually, to the royal court of Mysore.
As today, there was fear and opposition to the vaccine, especially in India, because it was foreign, threatened local healers who used variolation, and the use of vaccine couriers meant that “the vaccine was passing through bodies of all races, religions, castes and genders, and that ran counter to unyielding Hindu notions of purity.”
To counter the opposition, the British started an advertising campaign featuring Indian royalty. The picture above, for example, according to one compelling interpretation shows three Indian queens of Mysore with the queen on the right prominently portraying her arm where she has been inoculated with cowpox while the older queen on the left shows the discoloration around the mouth associated with smallpox. Thus, the younger queen on the right symbolizes health, vigor and the value of British science.
The challenges of delivering a vaccine in the 19th century–storage, transportation, fear, and incentives–are surprisingly similar to the challenges we face today. The 19th century effort to deliver the smallpox vaccine was impressive. Within years of Jenner’s pamphlet, the vaccine had made its way around the world. The 21st century effort will need to be much larger. Our civilization has many more resources than that of the 19th century. I hope we can match their will and ingenuity.
Further results on the return to talk therapy
Here was my original post, here is an email response from a specialist in the area, channeled by a reader:
The issue is really, really complicated. I have a lot of data on it because I spent time with Mark Goldenson, interviewing a lot of folks segmented by those who chose to seek mental health assistance from a clinician, those who stayed with that treatment versus those who turned away relatively early, and those who experienced severe mental health conditions that make them think that they should have seen a therapist, but ultimately chose not to, for reasons other than economic ones.
And we also talked to clinicians on the other side of that equation.
So between that and knowing the literature reasonably well, I have a lot of perspective on this.
The first thing is that talk therapy is in general not effective for most people. And I know the paper under examination showed that it’s more effective than antidepressants, but in general, most people do not generally stick with talk therapy. They get a benefit at a reasonably low rate for a reasonably short period of time…
Moreover, there’s some pretty strong evidence that talk therapy or at least CBT is becoming less effective over time – the effect sizes in studies & meta-analyses are going down. And there could be reasons for that that aren’t an indictment of the therapeutic model.
So for example, the modern world could just be becoming more stressful and the therapy is less equipped for it… It could be that as the treatment becomes more popular, rather than the more advanced or cutting-edge therapists using it, it’s used by an increasingly broad set of therapists that include low-skilled or ineffective ones.
So there are a lot of reasons that may not have to do with the merits of CBT as an approach, but the data are reasonably convincing on that front.
I think a lot of people are making a reasonably rational choice that, especially if they’re not going to stick with it for a long period of time, even starting therapy is a low-value proposition.
George Ainslie (the psychologist) has this kind of notion of playing a prisoner’s dilemma with your [future] self… let’s just say I want to start an exercise habit… there are a lot of parallels with exercise and talk therapy.
If I knew for a fact that I was going to stop doing it after one month, it actually doesn’t make sense to start at all. Right, because the benefits of accrued will pretty rapidly deteriorate and it’ll be as if I never did it…
People are not just considering, “Should I try talk therapy?”, they’re considering, “Will I do this for a sufficiently long period of time, or especially can I afford it for a long period of time, to where I will get and maintain the benefits from doing it?”
And many people do in fact have misinformation about how quickly they can experience certain types of benefits, and how much work is involved – it’s clear that there’s a lot of work involved, and many people don’t want to do that work.
From an operant conditioning standpoint, the experience of a therapy session is frankly more punishing than it is rewarding (for many people, a lot of the time). Like any negative stimulus, they’re going to engage in behaviors that cause that stimulus to be experienced at a lower rate.
Sometimes the benefits don’t accrue during the session, they accrue afterwards. It takes a lot of work to experience them and [can] involve emotional trauma to even retrieve them.
It’s not consistent with people’s ROI calculation, or what they would like to see in their ROI calculation. Again, it’s really similar to physical exercise – we know physical exercise works. It works better than antidepressants. It accrues all the benefits that this paper Cowen cited discovered in terms of energy and mood and earnings and so on and so forth.
But people still don’t engage in exercise, and in fact I think the rate of physical activity is actually on the decline, in the industrialized world at least.So, it’s more complex than “Does the behavior accrue benefits if you do it consistently?” It’s also not entirely about access because many forms of physical activity are free, and as the paper examines the seeking of talk therapy is not super sensitive to [price].
So it goes beyond the mere cost of the service, although the cost of the services is definitely prohibitive for a large cross-section of people.
How does ketamine or any other substance relate to this?
I think it relates very favorably in that people may actually have the opposite misconception around psychedelic-assisted therapy. They might view regular talk therapy as something where they’re going to have to do this tedious hour a week for months before they get any benefits or they solve any problems in their lives.
[With ketamine] they probably think that they’re going to do one ketamine session, and all of their issues are going to be solved right their PTSD is cured and they no longer experience any symptoms of anxiety, depression, etc… It’s probably a little bit overhyped in the minds of people who have only casually exposed themselves – they’re seeing an article in The New Yorker, or they’re seeing it on a blog, or someone goes on a podcast and talks about an experience. They’re not looking at it with the measured view of someone from the Johns Hopkins team or whatever. So I think that it does work in your favor….
People may overestimate the level of benefit they’re likely to achieve and it seems like the medicine is doing the work, rather than them. Even though I know that that isn’t really the case….
By the way, fun stuff from that research sprint we did with Goldenson – the average person in our cohort (who did ultimately get therapy), put it off for over two years.
It was a pretty wide range – some people sought help after, perhaps, six weeks I think was the shortest. Nobody has a bad day or think they’re experiencing depression or experiencing dysfunction in their work life or their romantic life or whatever it is and goes straight to a therapist…
They also tend to do a fair bit of research – they research different therapeutic methods and kind of choose one that fits their personality or their values, almost more so than efficacy.
And most of the people who ended up with a stable relationship with a provider trial between two and five different folks.
Those words are from Chris York, via MR reader Milan Griffes.
When did average end?
There was a dramatic negative structural break in college graduates’ employment rates, beginning around the 2005 entry cohort, that shows no sign of abating.
Here is the full NBER paper from Jesse Rothstein.
Rereading Ayn Rand on the New Left
It used to be called The New Left: The Anti-Industrial Revolution, but the later title was Return of the Primitive. It was published in 1971, but sometimes drawn from slightly earlier essays. I wondered if a revisit might shed light on the current day, and here is what I learned:
1. “The New Left is the product of cultural disintegration; it is bred not in the slums, but in the universities; it is not the vanguard of the future, but the terminal stage of the past.”
2. The moderates who tolerate the New Left and its anti-reality bent can be worse than the New Left itself.
3. Ayn Rand wishes to cancel the New Left, albeit peacefully.
4. “Like every other form of collectivism, racism is a quest for the unearned.” Ouch, it would be good to resuscitate this entire essay (on racism).
5. She fears the collapse of Europe into tribalism, racism, and balkanization. I am not sure if I should feel better or worse about the ongoing persistence of this trope.
6. It is easy to forget that English was not her first language: “Logical Positivism carried it further and, in the name of reason, elevated the immemorial psycho-epistemology of shyster lawyers to the status of a scientific epistemological system — by proclaiming that knowledge consists of linguistic manipulations.”
6b. Kant was the first hippie.
7. The majority of people do not hate the good, although they are disgusted by…all sorts of things.
8. Like many Russian women, she is skeptical of the American brand of feminism: “As a group, American women are the most privileged females on earth: they control the wealth of the United States — through inheritance from fathers and husbands who work themselves into an early grave, struggling to provide every comfort and luxury for the bridge-playing, cocktail-party-chasing cohorts, who give them very little in return. Women’s Lib proclaims that they should give still less, and exhorts its members to refuse to cook their husbands’ meals — with its placards commanding “Starve a rat today!”” Feminism for me, but not for thee, you could call it.
Overall I would describe this as a bracing reread. But what struck me most of all was how much the “Old New Left” — whatever you think of it — had more metaphysical and ethical and aesthetic imagination — than the New New Left variants running around today. As Rand takes pains to point out (to her dismay), the Old New Left did indeed have Woodstock, which in reality was not as far from the Apollo achievement as she was suggesting at the time.
Pooled Testing is Super-Beneficial
Tyler and I have been pushing pooled testing for months. The primary benefit of pooled testing is obvious. If 1% are infected and we test 100 people individually we need 100 tests. If we split the group into five pools of twenty then if we’re lucky, we only need five tests. Of course, chances are that there will be some positives in at least one group and taking this into account we will require 23.2 tests on average (5 + (1 – (1 – .01)^20)*20*5). Thus, pooled testing reduces the number of needed tests by a factor of 4. Or to put it the other way, under these assumptions, pooled testing increases our effective test capacity by a factor of 4. That’s a big gain and well understood.
An important new paper from Augenblick, Kolstad, Obermeyer and Wang shows that the benefits of pooled testing go well beyond this primary benefit. Pooled testing works best when the prevalence rate is low. If 10% are infected, for example, then it’s quite likely that all five pools will have at least one positive test and thus you will still need nearly 100 tests (92.8 expected). But the reverse is also true. The lower the prevalence rate the fewer tests are needed. But this means that pooled testing is highly complementary to frequent testing. If you test frequently then the prevalence rate must be low because the people who tested negative yesterday are very likely to test negative today. Thus from the logic given above, the expected number of tests falls as you tests more frequently (per test-cohort).
Suppose instead that people are tested ten times as frequently. Testing individually at this frequency requires ten times the number of tests, for 1000 total tests. It is therefore natural think that group testing also requires ten times the number of tests, for more than 200 total tests. However, this estimation ignores the fact that testing ten times as frequently reduces the probability of infection at the point of each test (conditional on not being positive at previous test) from 1% to only around .1%. This drop in prevalence reduces the number of expected tests – given groups of 20 – to 6.9 at each of the ten testing points, such that the total number is only 69. That is, testing people 10 times as frequently only requires slightly more than three times the number of tests. Or, put in a different way, there is a “quantity discount” of around 65% by increasing frequency.
Peter Frazier, Yujia Zhang and Massey Cashore also point out that you could also do an array-protocol in which each person is tested twice but in two different groups–this doubles the number of initial tests but limits the number of false-positives (both tests must be positive) and the number of needed retests. (See figure.). 
Moreover, we haven’t yet taken into account the point of testing which is to reduce the prevalence rate. If we test frequently we can reduce the prevalence rate by quickly isolating the infected population and by reducing the prevalence rate we reduce the number of needed tests. Indeed, under some parameters it’s possible to increase the frequency of testing and at the same time reduce the total number of tests!
We can do better yet if we group individuals whose risks are likely to be correlated. Consider an office building with five floors and 100 employees, 20 per floor. If the prevalence rate is 1% and we test people at random then we will need 23.2 tests on average, as before. But suppose that the virus is more likely to transmit to people who work on the same floor and now suppose that we pool each floor. Holding the total prevalence rate constant, we are now likely to have a zero prevalence rate on four floors and a 5% prevalence rate on one floor. We don’t know which floor but it doesn’t matter–the expected number of tests required now falls to 17.8.
The authors suggest using machine learning techniques to uncover correlations which is a good idea but much can be done simply by pooling families, co-workers, and so forth.
The government has failed miserably at controlling the pandemic. Tens of thousands of people have died who would have lived under a more competent government. The FDA only recently said they might allow pooled testing, if people ask nicely. Unbelievably, after telling us we don’t need masks (supposedly a noble lie to help limit shortages), the CDC is still disparaging testing of asymptomatic people (another noble lie?) which is absolutely disastrous. Paul Romer is correct, testing capacity won’t increase until we put soft drink money behind advance market commitments and start using techniques such as pooled testing. Fortunately or sadly, depending on how you look at it, it’s not too late to do better. Some universities are now proposing rapid, frequent testing using pooling. Harvard will test every three days. Cornell will test frequently. Delaware State will test weekly. Lets hope the idea spreads from the ivory tower.
New York algebra fact of the day
Take here in New York, where in 2016 the passing rate for the Regents Examination in Algebra I test was 72 percent. Unfortunately, this (relatively) higher rate of success does not indicate some sort of revolutionary pedagogy on the part of New York state educators. As the New York Post complained in 2017, passing rates were so high in large measure because the cutoff for passing was absurdly low — so low that students needed only to answer 31.4 percent of the questions correctly to pass the 2017 exam.
That is from Freddie deBoer, who has returned to writing, and who argues lower standards and higher graduation rates are a good thing, all matters considered.
And here is another education result of note: “We estimate a dynamic model of schooling on two cohorts of the NLSY and find that, contrary to conventional wisdom, the effects of real (as opposed to relative) family income on education have practically vanished between the early 1980’s and the early 2000’s.”
Human Challenge Trials for vaccines
From an anonymous reader:
As you are of course aware, testing on vaccines for Covid-19 are beginning to be undertaken. The scientific community has seemingly decided that Human Challenge Trials (HCT) where test subjects are directly exposed to the virus following vaccination are unethical, instead using the typical protocol of vaccine/placebo inoculation followed by months of observation in order to observe effectiveness. This seems to me a grave moral error based on the following argument.
1) There exists a large cohort of young, healthy, fully informed, willing participants who would undergo HCT.
2) Given the mortality profile of this disease, these participants would be undertaking an exceptionally small mortality risk (perhaps 5-10 per 100k, based on data from Spain/Italy/NYC, assuming zero vaccine effectiveness).
3) Society deems acceptable other activities with much higher fatality risk (at least 5-10x) in both professional (soldiers, logging workers) and recreational (motorcycling, mountaineering) capacities.
4) HCT would speed up the vaccine testing process by many months, saving tens of thousands of lives and avoiding enormous economic damage.
5) HCT actually poses significantly less risk to participants in terms of allergic reaction or ADE risk compared to a standard testing protocol since the number of participants could be much smaller and they would be medically observed.
I fail to find any ethical justification for the current stance of the medical community, from either a utilitarian or deontological perspective, and believe a highly consequential error is being made. This error may be based on false analogies to past unethical testing practices in history where participants were not informed or willing and danger was significant. The current case bears no ethical resemblance, in my judgement, to these past cases.
The simplest model of such errors is that many members of the biomedical establishment do not wish to have bad feelings about any “sins of commission” and to see their status lowered as a result of “dirty hands,” and the readily criticized logistics of Human Challenge Trials. Since HCTs do not “feel right” to them, they self-deceive into associating that feeling with a concern for the greater public good.
You should not be surprised to see grave moral errors committed in a crisis, however. Our “mainstream” protection against grave moral errors, in normal circumstances, simply is that usually we are not given the opportunity to commit them.
I do understand that a Human Challenge Trial does not necessarily suffice to show that a given vaccine is safe. Nonetheless it should be in the “armor of our discourse,” so to speak, as a morally acceptable alternative. So if you are a biomedical professional, or a public intellectual, I hope you will speak up.
Here is a Matt Yglesias piece on the urgency of developing a vaccine as quickly as possible. Eric Weinstein notes that women risk their lives every time they proceed with having children.
Why isn’t Sweden exploding?
…Swedish state epidemiologist Anders Tegnell remains calm: he is not seeing the kind of rapid increase that might threaten to overwhelm the Swedish health service, and unlike policymakers in the UK, he has been entirely consistent that that is his main objective.
That is from a new piece by Freddie Sayers, asserting that “the jury is still out” when it comes to Sweden. I cannot reproduce all of the graphs in that piece, but scroll through and please note that in terms of per capita deaths Sweden seems to be doing better than Belgium, France, or the United Kingdom, all of which have serious lockdowns (Sweden does not). If you measure extant trends, Sweden is in the middle of the pack for Europe. And here is data on new hospital admissions:
Now I understand that ideally one should compare similar “time cohorts” across countries, not absolute numbers or percentages. That point is logically impeccable, but still as the clock ticks it seems less likely to account for the Swedish anomaly.
Of course we still need more days and weeks of data.
To be clear, I am not saying the United States can or should copy Sweden. Sweden has an especially large percentage of people living alone, the Swedes are probably much better at complying with informal norms for social distancing, and obesity is much less of a problem in Sweden than America, probably hypertension too.
But I’d like to ask a simple question: who predicted this and who did not? And which of our priors should this cause us to update?
I fully recognize it is possible and maybe even likely that Sweden ends up being like Japan, in the sense of having a period when things seem (relatively) fine and then discovering they are not. (Even in Singapore the second wave has arrived, from in-migration, and may well be worse than the first.) But surely the chance of that scenario has gone down just a little?
And here is a new study on Lombardy by Daniil Gorbatenko:
The data clearly suggest that the spread had been trending down significantly even before the initial lockdown. They invalidate the fundamental assumption of the Covid-19 epidemiological models and with it, probably also the rationale for the harshest measures of suppression.
One possibility (and I stress that word possibility) is that these Lombardy data, shown at the link, are reflecting the importance of potent “early spreaders,” often family members, who give Covid-19 to their families fairly quickly, but after which the average rate of spread falls rapidly.
I’ll stand by my claim that the pieces on this one show an increasing probability of not really adding up. In the meantime, I am very happy to pull out and signal boost the best criticisms of these results.
Why I do not favor variolation for Covid-19
Robin Hanson makes the strongest case for variolation, here is one excerpt:
So the scenario is this: Hero Hotels welcome sufficiently young and healthy volunteers. Friends and family can enter together, and remain together. A cohort enters together, and is briefly isolated individually for as long as it takes to verify that they’ve been infected with a very small dose of the virus. They can then interact freely with each other, those those that show symptoms are isolated more. They can’t leave until tests show they have recovered.
In a Hero Hotel, volunteers have a room, food, internet connection, and full medical care. Depending on available funding from government or philanthropic sources, volunteers might either pay to enter, get everything for free, or be paid a bonus to enter. Health plans of volunteers may even contribute to the expense.
Do read the whole thing. By the way, here is “Hotel Corona” in Tel Aviv. Alex, by the way, seems to endorse Robin’s view. Here are my worries:
1. Qualified medical personnel are remarkably scarce right now. I do not see how it is possible to oversee the variolation of more than a small number of individuals. Furthermore, it is possible that many medical personnel would refuse to oversee the practice. The net result would be only a small impact on herd immunity. If you doubt this, just consider how bad a job we Americans have done scaling up testing and making masks.
The real question right now is what can you do that is scalable? This isn’t it.
I recall Robin writing on Twitter that variolation would economize on the number of medical personnel. I think it would take many months for that effect to kick in, or possibly many years.
2. Where will we put all of the Covid-positive, contagious individuals we create? What network will we use to monitor their behavior? We have nothing close to the test and trace systems of Singapore and South Korea.
In essence, we would have to send them home to infect their families (the Lombardy solution) or lock them up in provisional camps. Who feeds and takes care of them in those camps, and what prevents those individuals from becoming infected? What is the penalty for trying to leave such a camp? Is our current penal system, or for that matter our current military — both longstanding institutions with plenty of experienced personnel — doing an even OK job of overseeing Covid-positive individuals in their midst? I think not.
Under the coercive approach, what is the exact legal basis for this detention? That a 19-year-old signed a detention contract? Is that supposed to be binding on the will in the Rousseauian sense? Where are the governmental structures to oversee and coordinate all of this? Should we be trusting the CDC to do it? Will any private institutions do it without complete governmental cover? I don’t think so.
If all this is all voluntary, the version that Robin himself seems to favor, what percentage of individuals will simply leave in the middle of their treatment? Robin talks of “Hero Hotels,” but which actual hotels will accept the implied liability? There is no magic valve out there to relieve the pressure on actual health care systems. Note that the purely voluntary version of Robin’s plan can be done right now, but does it seem so popular? Is anyone demanding it, any company wishing it could do it for its workforce?
3. The NBA has an amazing amount of money, on-staff doctors, the ability to afford tests, and so on. And with hundreds of millions or billions of dollars at stake they still won’t restart a crowdless, TV-only season. They could indeed run a “Heroes Hotel” for players who got infected from training and play, and yet they won’t. “Stadium and locker room as Heroes Hotel” is failing the market test. Similarly, colleges and universities have a lot at stake, but they are not rushing to volunteer their dorms for this purpose, even if it might boost their tuition revenue if it went as planned (which is not my prediction, to be clear).
The proposal requires institutions to implement it, yet it doesn’t seem suited for any actual institution we have today.
4. Does small/marginal amounts of variolation do much good compared to simply a weaker lockdown enforcement for activities that involve the young disproportionately? Just tell the local police not to crack down on those soccer games out in the park (NB: I am not recommending this, rather it is the more practical version of what Robin is recommending; both in my view are bad ideas.) Robin’s idea has the “Heroes Hotel” attached, but that is a deus ex machina that simply assumes a “free space” (both a literal free space and a legally free space) is available for experimentation, which it is not.
5. Society can only absorb a small number of very blunt messages from its leaders. You can’t have the President saying “this is terrible and you all must hide” and “we’re going to expose our young” and expect any kind of coherent response. People are already confused enough from mixed messages from leaders such as presidents and governors.
6. There is still a chance that Covid-19 causes or induces permanent damage, perhaps to the heart and perhaps in the young as well. That does not militate in favor of increasing the number of exposures now, especially since partial protective measures (e.g., antivirals, antibodies) might arise before a vaccine does. This residual risk, even if fairly small, also makes the liability issues harder to solve.
7. The actual future of the idea is that as lockdown drags on, many individuals deliberately will become less careful, hoping to get their infections over with. A few may even infect themselves on purpose, one hopes with a proper understanding of dosage. One can expect this practice will be more popular with the (non-obese) young. The question is then how to take care of those people and how to treat them. That debate will devolve rather rapidly into current discussions of testing, test and trace, self-isolation, antivirals, triage, and so on. And then it will be seen that variolation is not so much of a distinct alternative as right now it seems to be.
8. The main benefit of variolation proposals is to raise issues about the rates at which people get infected, and the sequencing of who is and indeed should be more likely to get infected first. Those questions deserve much more consideration than they are receiving, and in that sense I am very happy to see variolation being brought (not much risk of it happening as an explicit proposal). That said, I don’t think Heroes Hotel, and accelerating the rate of deliberate, publicly-intended infection, is the way to a better solution.
Soon I’ll write more on what I think we should be doing, but I would not put explicit variolation above the path of the status quo.
What should you read during the crisis?
Agnes Callard writes (NYT):
Like many others, I have been finding my taste in books and movies turning in an apocalyptic direction. I also find myself much less able than usual to hold these made-up stories at a safe distance from myself…
If I have something to feel guilty about, I want to feel guilty. If something frightening is happening, I want to be afraid of it. Which is to say: When things are bad, I want to suffer and would choose to suffer and even seek out suffering.
Having just rewatched Bergman’s The Seventh Seal, and then The Virgin Spring, I agree at the margin, but not altogether. I would raise the following points:
1. In times of turmoil, we may have a stronger craving for art that “feels real.” But such art is in fact often especially phony. The “special effects” have to be all the better, so to speak. None of what we are consuming is a realistic experience in the first place, so perhaps we are seeking out greater artifice and fooling ourselves about its realism even more than usual.
2. Should we be watching videos of bad events in hospitals? (originally Chinese hospitals, now NYC). Some people are indeed doing this, but as a substitute for Jane Austen? How about videos of people dying from Covid-19? Videos of other respiratory diseases as the next best fill-in?
3. What about the art vs. non-art margin as a larger choice? Don’t many people with terminal diseases (more terminal than usual that is) want to go for long walks in nature? Doesn’t fiction exercise much less of a hold on elderly minds and matter most for teenagers and people in their early 20s and perhaps also women in their 40s-50s? Perhaps the implication is, during a pandemic, to move away from art and literary fiction altogether.
4. The Guardian reports that sales of long, classic novels have gone up. What do those novels have in common? Are they a kind of comfort food? Do we value their length? That they are high status? That we read them already in earlier and perhaps happier periods of life? Are they long projects we can absorb ourselves in? Those seem like illusion-laden motives for reading them, “not that there’s anything wrong with that.”
5. Perhaps we like to read especially pessimistic dystopian novels as a kind of talisman. “Tell me the worst, let’s get dealing with the fear over with, then I will feel protected that reality will not disappoint my expectations because things won’t in fact be that bad.” That is again another kind of illusion. The aforementioned Guardian link suggests that sales of dystopian novels are up in general, even if they are not about plagues and pandemics.
6. Yiyun Li said: ““I have found that the more uncertain life is, the more solidity and structure Tolstoy’s novels provide. In these times, one does want to read an author who is so deeply moved by the world that he could appear unmoved in his writing,” she wrote.”
7. If people are bored, should they then wish to experience further boredom through their choice of fiction? Or would a diversion from boredom be acceptable and indeed preferred?
Somehow I think in terms of a portfolio approach to aesthetics. In harder times you need more tugs, pulls, distractions, and offsets than usual, but they should not all run in the same direction, or they will become predictable and cease to move you.
So when it comes to fiction, take some chances in your reading and toss in some of the older classics and horror and dystopia as well, and lots of fun and warmth and those walks in nature too.
So yes make a (marginal) turn in the apocalyptic direction, but in part it is to shore up your own sappiness.
Emergent Ventures India
Thanks to a special grant, there is now a devoted tranche of Emergent Ventures India. In the last two years, EV has received excellent applications related to India, both from residents in India and entrepreneurs and academics around the world working on India-related projects. This is not surprising because India has exceptional young talent with great ideas, but its traditional educational and philanthropic institutions have not always identified and nurtured these ideas and individuals. And given the size of the opportunity in India, a successful idea can change the lives of a very large number of people. In this sense, EV India is our attempt at a moonshot.
And a given dollar goes much further there!
Those unfamiliar with Emergent Ventures can learn more here and here.
EV India will provide grants and micro grants to jump-start high-reward ideas that advance prosperity, opportunity, liberty, and the well-being of Indians. We encourage unorthodox ideas and also requests that are too small to attract interest from the traditional models of funding and philanthropy.
Shruti Rajagopalan (also an Emergent Ventures Winner) joined Mercatus in the fall of 2019 as a senior research fellow studying Indian political economy and economic development. Shruti and I (Tyler) are already working together to evaluate applications for EV India. And note we are now working on some Covid-19-related grants!
To apply for EV India, use the EV application click the “Apply Now” button and select India from the “My Project Will Affect” drop-down menu.
Here is a list of past grants and fellowships made to India related projects:
Harshita Arora (first EV cohort), an 18-year-old Indian prodigy from Saharanpur, in addition to her work in the sciences, she recently co-founded AtoB, a startup building a sustainable transportation network for intercity commuters using buses.
Neil Deshmukh, high school student in Pennsylvania, for general career support and also to support his work on smartphone apps for helping Indian farmers identify, diagnose, and recommend treatment options for crop diseases (PlantumAI) and for helping the blind and visually impaired interpret images through sound (VocalEyes).
Paul Novosad, at Dartmouth, with Sam Asher, at Johns Hopkins, to enable the construction of a scalable platform for the integration and dissemination of socioeconomic data in India, ideally to cover every town and village, toward the end of informing actionable improvements. The Socioeconomic High-resolution Rural-Urban Geographic Dataset on India (SHRUG) is available here.
Tejas Subramaniam, a high schooler from Chennai, for prospective work on disseminating information about the prevalence of sexual violence, the harm it does, and effective tools to reduce its incidence. Tejas (with his team) won the World Schools Debating Championships (WSDC) in August 2019.
Namrata Narain, Harvard Ph.D student in economics, for work on “What happens to the ability of firms to write contracts when courts are dysfunctional?”
Samarth Jajoo, a high school student in Ahmedabad, India, to assist in his purchase of study materials for math, computer science, and tutoring. He has developed a project called read.gift, which is a new book gifting project.
Himanshu Dhingra, an entrepreneurial Indian law student, to support his travel and internship at Project Arizona.
Ashish Kulkarni, an economics professor at Gokhale Institute of Politics and Economics, to support a podcast on asynchronous mentoring.
Shrirang Karandikar, to support an Indian project to get the kits to measure and understand local pollution.
If you are interested in supporting the India tranche of Emergent Ventures, please write to me or to Shruti at [email protected].
Emergent Ventures prize winners for coronavirus work
I am happy to announce the first cohort of Emergent Ventures prize winners for their work fighting the coronavirus. Here is a repeat of the original prize announcement, and one week or so later I am delighted there are four strong winners, with likely some others on the way. Again, this part of Emergent Ventures comes to you courtesy of the Mercatus Center and George Mason University. Here is the list of winners:
Social leadership prize: Helen Chu and her team at the University of Washington. Here is a NYT article about Helen Chu’s work, excerpt:
Dr. Helen Y. Chu, an infectious disease expert in Seattle, knew that the United States did not have much time…
As luck would have it, Dr. Chu had a way to monitor the region. For months, as part of a research project into the flu, she and a team of researchers had been collecting nasal swabs from residents experiencing symptoms throughout the Puget Sound region.
To repurpose the tests for monitoring the coronavirus, they would need the support of state and federal officials. But nearly everywhere Dr. Chu turned, officials repeatedly rejected the idea, interviews and emails show, even as weeks crawled by and outbreaks emerged in countries outside of China, where the infection began.
By Feb. 25, Dr. Chu and her colleagues could not bear to wait any longer. They began performing coronavirus tests, without government approval.
What came back confirmed their worst fear. They quickly had a positive test from a local teenager with no recent travel history. The coronavirus had already established itself on American soil without anybody realizing it.
And to think Helen is only an assistant professor.
Data gathering and presentation prize: Avi Schiffmann
Here is a good write-up on Avi Schiffmann, excerpt:
A self-taught computer maven from Seattle, Avi Schiffmann uses web scraping technology to accurately report on developing pandemic, while fighting misinformation and panic.
Avi started doing this work in December, remarkable prescience, and he is only 17 years old. Here is a good interview with him:
I’d like to be the next Avi Schiffmann and make the next really big thing that will change everything.
Here is Avi’s website, ncov2019.live/data.
Prize for good policy thinking: The Imperial College researchers, led by Neil Ferguson, epidemiologist.
Neil and his team calculated numerically what the basic options and policy trade-offs were in the coronavirus space. Even those who disagree with parts of their model are using it as a basic framework for discussion. Here is their core paper.
The Financial Times referred to it as “The shocking coronavirus study that rocked the UK and US…Five charts highlight why Imperial College’s research radically changed government policy.”
The New York Times reported “White House Takes New Line After Dire Report on Death Toll.” Again, referring to the Imperial study.
Note that Neil is working on despite having coronavirus symptoms. His earlier actions were heroic too:
Ferguson has taken a lead, advising ministers and explaining his predictions in newspapers and on TV and radio, because he is that valuable thing, a good scientist who is also a good communicator.
Furthermore:
He is a workaholic, according to his colleague Christl Donnelly, a professor of statistical epidemiology based at Oxford University most of the time, as well as at Imperial. “He works harder than anyone I have ever met,” she said. “He is simultaneously attending very large numbers of meetings while running the group from an organisational point of view and doing programming himself. Any one of those things could take somebody their full time.
“One of his friends said he should slow down – this is a marathon not a sprint. He said he is going to do the marathon at sprint speed. It is not just work ethic – it is also energy. He seems to be able to keep going. He must sleep a bit, but I think not much.”
Prize for rapid speedy response: Curative, Inc. (legal name Snap Genomics, based in Silicon Valley)
Originally a sepsis diagnostics company, they very rapidly repositioned their staff and laboratories to scale up COVID-19 testing. They also acted rapidly, early, and pro-actively to round up the necessary materials for such testing, and they are currently churning out a high number of usable test kits each day, with that number rising rapidly. The company is also working on identifying which are the individuals most like to spread the disease and getting them tested first. here is some of their progress from yesterday.
Testing and data are so important in this area.
General remarks and thanks: I wish to thank both the founding donor and all of you who have subsequently made very generous donations to this venture. If you are a person of means and in a position to make a donation to enable this work to go further, with more prizes and better funded prizes, please do email me.
The Lasting Effects of the 1918 Influenza Pandemic
[I’ve never put a trigger warning on a post before but given the current situation the information here is potential upsetting to anyone expecting a child. I do not think that the current pandemic will be as bad as the 1918. I am also hopeful that the weather will work in our favor and that, as Tyler argued, America will start to work. Do also read my post, What Worked in 1918-1919 for a more positive message.]
The 1918 influenza pandemic struck the United States with most ferocity in October of 1918 and then over the next four months killed more people than all the US combat deaths of the 20th century. The sudden nature of the pandemic meant that children born just months apart experienced very different conditions in utero. In particular, children born in 1919 were much more exposed to influenza in utero than children born in 1918 or 1920. The sudden differential to the 1918 flu lets Douglas Almond test for long-term effects in Is the 1918 Influenza Pandemic Over?
Almond finds large effects many decades after exposure.
Fetal health is found to affect nearly every socioeconomic outcome recorded in the 1960, 1970, and 1980 Censuses. Men and women show large and discontinuous reductions in educational attainment if they had been in utero during the pandemic. The children of infected mothers were up to 15 percent less likely to graduate from high school. Wages of men were 5–9 percent lower because of infection. Socioeconomic status…was substantially reduced, and the likelihood of being poor rose as much as 15 percent compared with other cohorts. Public entitlement spending was also increased.
At right, for example, are male disability rates in 1980, i.e. for males around the age of 60, by year and quarter of birth. Cohorts born between January and September of 1919 “were in utero at the height of the pandemic and are estimated to have 20 percent higher disability rates at age 61…”.
Figure 3 at right shows average years of schooling in 1960; once again the decline is clear for those born in 1918 and note that not all pregnant women contracted influenza so the actual effects of influenza exposure are larger, about a 5 month decline in education, mostly coming through lower graduate rates.
Higher disability and lower education translate into greater government payments as show in the final figure below. Almond labels these welfare payments which might be slightly misleading–these are Social Security Disability payments in 1970. Here’s Almond:
Average payments to women and nonwhites in 1970 are plotted in figure 8. The average welfare payment was 12 percent higher for both women and nonwhites born in 1919, or approximately one-third higher for children of
mothers who contracted influenza. When we focus on quarter of birth, it is apparent that these increased payments are generated by high payments to those born between April and June of 1919.
Note that men and women who were especially disabled could have died before 1970 and so these are lower bounds on the disability impact.
Fetal exposure seems to be the key as Almond tests for and rejects other possibilities. The 1918 kids, for example, seem about the same as the 1920 kids so it’s not that the flu killed off the weak kids in 1918.
Almond was interested in the 1918 pandemic not simply as a historical episode but to make the case that infant health and infant health programs have high benefit to cost ratios, a still relevant lesson.
Hat tip: Wojtek Kopczuk.
Revisiting Latino economic assimilation
Here is a new paper by Giovanni Peri and Zachariah Rutledge
Using data from the United States spanning the period between 1970 and 2017, we analyze the economic assimilation of subsequent arrival cohorts of Mexican and Central American immigrants, the more economically disadvantaged group of immigrants. We compare their wage and employment probability to that of similarly aged and educated natives across various cohorts of entry. We find that all cohorts started with a disadvantage of 40-45 percent relative to the average US native, and eliminated about half of it in the 20 years after entry. They also started with no employment probability disadvantage at arrival and they overtook natives in employment rates so that they were 5-10 percent more likely to be employed 20 years after arrival. We also find that recent cohorts, arriving after 1995, did better than earlier cohorts both in initial gap and convergence. We show that Mexicans and Central Americans working in the construction sector and in urban areas did better in terms of gap and convergence than others. Finally, also for other immigrant groups, such as Chinese and Indians, recent cohorts did better than previous ones.
Via the excellent Kevin Lewis.