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Spit Works

A new paper finds that COVID-19 can be detected in saliva more accurately than with nasal swab. As I mentioned earlier a saliva test will lessen the need for personnel with PPE to collect samples.

Rapid and accurate SARS-CoV-2 diagnostic testing is essential for controlling the ongoing COVID-19 pandemic. The current gold standard for COVID-19 diagnosis is real-time RT-PCR detection of SARS-CoV-2 from nasopharyngeal swabs. Low sensitivity, exposure risks to healthcare workers, and global shortages of swabs and personal protective equipment, however, necessitate the validation of new diagnostic approaches. Saliva is a promising candidate for SARS-CoV-2 diagnostics because (1) collection is minimally invasive and can reliably be self-administered and (2) saliva has exhibited comparable sensitivity to nasopharyngeal swabs in detection of other respiratory pathogens, including endemic human coronaviruses, in previous studies. To validate the use of saliva for SARS-CoV-2 detection, we tested nasopharyngeal and saliva samples from confirmed COVID-19 patients and self-collected samples from healthcare workers on COVID-19 wards. When we compared SARS-CoV-2 detection from patient-matched nasopharyngeal and saliva samples, we found that saliva yielded greater detection sensitivity and consistency throughout the course of infection. Furthermore, we report less variability in self-sample collection of saliva. Taken together, our findings demonstrate that saliva is a viable and more sensitive alternative to nasopharyngeal swabs and could enable at-home self-administered sample collection for accurate large-scale SARS-CoV-2 testing.

The FDA has also just approved an at-home test collected by nasal swab, a saliva test should not be far behind.

Hat tip: Cat in the Hat.

What should we believe and not believe about R?

This is from my email, highly recommended, and I will not apply further indentation:

“Although there’s a lot of pre-peer-reviewed and strongly-incorrect work out there, I’ll single out Kevin Systrom’s rt.live as being deeply problematic. Estimating R from noisy real-world data when you don’t know the underlying model is fundamentally difficult, but a minimal baseline capability is to get sign(R-1) right (at least when |R-1| isn’t small), and rt.live is going to often be badly (and confidently) wrong about that because it fails to account for how the confirmed count data it’s based on is noisy enough to be mostly garbage. (Many serious modelers have given up on case counts and just model death counts.) For an obvious example, consider their graph for WA: it’s deeply implausible on its face that WA had R=.24 on 10 April and R=1.4 on 17 April. (In an epidemiological model with fixed waiting times, the implication would be that infectious people started interacting with non-infectious people five times as often over the course of a week with no policy changes.) Digging into the data and the math, you can see that a few days of falling case counts will make the system confident of a very low R, and a few days of rising counts will make it confident of a very high one, but we know from other sources that both can and do happen due to changes in test and test processing availability. (There are additional serious methodological problems with rt.live, but trying to nowcast R from observed case counts is already garbage-in so will be garbage-out.)

However, folks are (understandably, given the difficulty and the rush) missing a lot of harder stuff too. You linked a study and wrote “Good and extensive west coast Kaiser data set, and further evidence that R doesn’t fall nearly as much as you might wish for.” We read the study tonight, and the data set seems great and important, but we don’t buy the claims about R at all — we think there are major statistical issues. (I could go into it if you want, although it’s fairly subtle, and of course there’s some chance that *we’re* wrong…)

Ultimately, the models and statistics in the field aren’t designed to handle rapidly changing R, and everything is made much worse by the massive inconsistencies in the observed data. R itself is a surprisingly subtle concept (especially in changing systems): for instance, rt.live uses a simple relationship between R and the observed rate of growth, but their claimed relationship only holds for the simplest SIR model (not epidemiologically plausible at all for COVID-19), and it has as an input the median serial interval, which is also substantially uncertain for COVID-19 (they treat it as a known constant). These things make it easy to badly missestimate R. Usually these errors pull or push R away from 1 — rt.live would at least get sign(R – 1) right if their data weren’t garbage and they fixed other statistical problems — but of course getting sign(R – 1) right is a low bar, it’s just figuring out whether what you’re observing is growing or shrinking. Many folks would actually be better off not trying to forecast R and just looking carefully at whether they believe the thing they’re observing is growing or shrinking and how quickly.

All that said, the growing (not total, but mostly shared) consensus among both folks I’ve talked to inside Google and with academic epidemiologists who are thinking hard about this is:

  • Lockdowns, including Western-style lockdowns, very likely drive R substantially below 1 (say .7 or lower), even without perfect compliance. Best evidence is the daily death graphs from Italy, Spain, and probably France (their data’s a mess): those were some non-perfect lockdowns (compared to China), and you see a clear peak followed by a clear decline after basically one time constant (people who died at peak were getting infected right around the lockdown). If R was > 1 you’d see exponential growth up to herd immunity, if R was 0.9 you’d see a much bigger and later peak (there’s a lot of momentum in these systems). This is good news if true (and we think it’s probably true), since it means there’s at least some room to relax policy while keeping things under control. Another implication is the “first wave” is going to end over the next month-ish, as IHME and UTexas (my preferred public deaths forecaster; they don’t do R) predict.
  • Cases are of course massively undercounted, but the weight of evidence is that they’re *probably* not *so* massively undercounted that we’re anywhere near herd immunity (though this would of course be great news). Looking at Iceland, Diamond Princess, the other studies, the flaws in the Stanford study, we’re very likely still at < ~2-3% infected in the US. (25% in large parts of NYC wouldn’t be a shock though).

Anyways, I guess my single biggest point is that if you see a result that says something about R, there’s a very good chance it’s just mathematically broken or observationally broken and isn’t actually saying that thing at all.”

That is all from Rif A. Saurous, Research Director at Google, currently working on COVID-19 modeling.

Currently it seems to me that those are the smartest and best informed views “out there,” so at least for now they are my views too.

Emergent Ventures Covid-19 prizes, second cohort

There is another round of prize winners, and I am pleased and honored to announce them:

1. Petr Ludwig.

Petr has been instrumental in building out the #Masks4All movement, and in persuading individuals in the Czech Republic, and in turn the world, to wear masks.  That already has saved numerous lives and made possible — whenever the time is right — an eventual reopening of economies.  And I am pleased to see this movement is now having an impact in the United States.

Here is Petr on Twitter, here is the viral video he had a hand in creating and promoting, his work has been truly impressive, and I also would like to offer praise and recognition to all of the people who have worked with him.

2. www.covid19india.org/

The covid19india project is a website for tracking the progress of Covid-19 cases through India, and it is the result of a collaboration.

It is based on a large volunteer group that is rapidly aggregating and verifying patient-level data by crowdsourcing.They portray a website for tracking the progress of Covid-19 cases through India and open-sources all the (non-personally identifiable) data for researchers and analysts to consume. The data for the react based website and the cluster graph are a crowdsourced Google Sheet filled in by a large and hardworking Ops team at covid19india. They manually fill in each case, from various news sources, as soon as the case is reported. Top contributor amongst 100 odd other code contributors and the maintainer of the website is Jeremy Philemon, an undergraduate at SUNY Binghamton, majoring in Computer Science. Another interesting contribution is from Somesh Kar, a 15 year old high school student at Delhi Public School RK Puram, New Delhi. For the COVID-19 India tracker he worked on the code for the cluster graph. He is interested in computer science tech entrepreneurship and is a designer and developer in his free time. Somesh was joined in this effort by his brother, Sibesh Kar, a tech entrepreneur in New Delhi and the founder of MayaHQ.

3. Debes Christiansen, the head of department at the National Reference Laboratory for Fish and Animal Diseases in the capital, Tórshavn, Faroe Islands.

Here is the story of Debes Christiansen.  Here is one part:

A scientist who adapted his veterinary lab to test for disease among humans rather than salmon is being celebrated for helping the Faroe Islands avoid coronavirus deaths, where a larger proportion of the population has been tested than anywhere in the world.

Debes was prescient in understanding the import of testing, and also in realizing in January that he needed to move quickly.

Please note that I am trying to reach Debes Christiansen — can anyone please help me in this endeavor with an email?

Here is the list of the first cohort of winners, here is the original prize announcement.  Most of the prize money still remains open to be won.  It is worth noting that the winners so far are taking the money and plowing it back into their ongoing and still very valuable work.

Pandemic Policy in Developing Countries: Recommendations for India

Shruti Rajagopalan and I have written a policy brief on pandemic policy in developing countries with specific recommendations for India. The Indian context requires a different approach. Even washing hands, for example, is not easily accomplished when hundreds of millions of people do not have access to piped water or soap. India needs to control the COVID-19 pandemic better than other nations because the consequences of losing control are more severe given India’s relatively low healthcare resources, limited state capacity, and large population of poor people, many of whom are already burdened with other health issues. We make 10 recommendations:

1: Any test kit approved in China, Japan, Singapore, South Korea, Taiwan, the United States, or Western Europe should be immediately approved in India.

2: The Indian government should announce a commitment to pay any private Indian lab running coronavirus tests at least the current cost of tests run at government labs. 

3: All import tariffs and quotas on medical equipment related to the COVID-19 crisis should be immediately lifted and nullified.

4: Use mobile phones to survey, inform, and prescreen for symptoms. Direct any individual with symptoms and his or her family to a testing center, or direct mobile testing to them.

5: Keep mobile phone accounts alive even if the phone bills are not paid, and provide a subsidy for pay-as-you-go account holders who cannot afford to pay for mobile services. 

6: Requisition government schools and buildings and rent private hotel rooms, repurposing them as quarantine facilities. 

7: Rapidly scale up the production and distribution of masks and encourage everyone to wear masks. 

8: Truck in water and soap for hand washing and use existing distribution networks to provide hand sanitizers. 

9: Accept voter identification cards and AADHAAR cards for in-kind transfers at ration shops.

10: Announce a direct cash transfer of a minimum of 3000 rupees per month (equivalent to the poverty line of $1.25 a day or $38 a month) to be distributed through Jan Dhan accounts or mobile phone applications such as Paytm.

See the whole thing for more on the rationales.

Addendum: As we went to press we heard that India will lift tariffs on medical equipment. My co-author lobbied hard for this.

Tuesday assorted links

1. Personal unemployment savings accounts.

2. “We find that [British] individuals living in regions in which local labor markets were more substantially affected by imports from China have significantly more authoritarian values.

3. “Residents in Republican counties are less likely to completely stay at home after a state order has been implemented relative to those in Democratic counties. We also find that Democrats are less likely to respond to a state-level order when it is issued by a Republican governor relative to one issued by a Democratic governor.”  Link here.

4. Could it be that scientists are dramatically rising in status? (NYT)

5. Pharma prices are not too high (usually).

6. Why are there so few heart attack patients right now? (NYT)  Even fewer than you might think, it seems.

7. Very substantive Colin Camerer interview.

8. Josh Angrist video on randomized trials, for Marginal Revolution University (which is seeing sky high traffic as of late).

9. The ongoing delays in testing (NYT).

10. “This NJ deli serves sandwiches on giant pickles instead of bread.

11. New journal publishes replication studies in economics.

12. Neil Ferguson interview, do we have an exit strategy?

13. New paper on suicide by Covid-19?

14. GDP loss estimates for Covid-19.

15. Omidyar Network India, rapid grants.

16. Michael Rosenwald history of pandemics, WaPo, splendid visuals.

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.

Thursday assorted links

1. Haircuts for airlines.  And time to prepare for voting by mail.

2. David Piling (FT) wonders whether India and Africa should do full lockdown.

3. Redundancy, not reshoring, is the key to supply chain security.

4. “Our classification implies that 34 percent of U.S. jobs can plausibly be performed at home.

5. Why was it so hard to raise the coronavirus alarm? (the yappers are one reason, btw — are you one of them?)

6. Under these calculations, an average coronavirus death in China means 11 years lost, 16 years lost in the United States.

7. The true CPI just jumped.

8. Are the new testing kits going to be sent to the American South, which has fewer measured cases?  Where should they be sent?  A good piece.

9. Economist Eric Budish on viewing R less than 1 as a fundamental economic constraint.

10. Overnight, Magnus Carlsen just revolutionized the future organization of chess play.  This will become the new normal.

11. Social distancing tips from a hermit.  “Keep track of something” is a good one.

12. How are the Amish adapting to shuttered schools?

13. Marginal Revolution University landing page for economic resources on coronavirus.

14. Peter Attia/Michael Osterholm podcast on Covid-19.

Wednesday assorted links

1. “…if the US stayed completely shut down for two months, the typical US worker would work about the same number of hours this year as a pre-pandemic German worker.”

2. Timeline of the federal government response to coronavirus.

3. Anti-price gouging laws mean masks leave America, I wonder if Alex is preparing a whole post on this link?

4. Holman Jenkins of the WSJ goes Straussian on the Straussian bloggers.

5. The culture that is Bengali priorities: sweet shops will stay open.  And a short history of coronavirus in Japan.  And Ezra Klein interviews Evan Osnos on coronavirus and U.S.-China relations.

6. Self-isolation proves a boon to rainfall project.

7. Why there are lags in scaling up California testing.  A very good (and depressing) piece.

8. Mossad officer describes their battle for ventilators.  And is the U.S. taking ventilators from Paraguay? (speculative)

9. The singing stops in southern Italy as tensions rise.

10. “Our infectiousness model suggests that the total contribution to R0 from pre-symptomatics is 0.9 (0.2 – 1.1), almost enough to sustain an epidemic on its own. For SARS, the corresponding estimate was almost zero (9), immediately telling us that different containment strategies will be needed for COVID-19.”  Link here.

11. Hospitals that won’t let their doctors wear masks (NYT).

12. Economist Peter Sinclair has died from Covid-19.

13. Should very young countries such as Nigeria opt for suppression?

14. Japan cries “Uncle!”

15. Our system of scientific funding is broken for rapid science (recommended).

A Solution if We Act

Many simulations have been run in recent weeks using standard epidemiological models and the emerging consensus, as I read it, is that test, trace and isolate can be very effective. Paul Romer’s simulations are here and he notes that a COVID-19 test does not have to be especially accurate for the test, trace and isolate strategy to work. Indeed, you don’t even need to trace, if you test enough people. Linnarsson and Taipale agree writing:

We propose an additional intervention that would contribute to the control of the COVID-19 pandemic and facilitate reopening of society, based on: (1) testing every individual (2) repeatedly, and (3) self-quarantine of infected individuals. By identification and isolation of the majority of infectious individuals, including the estimated 86% who are asymptomatic or undocumented, the reproduction number R0 of SARS-CoV-2 would be reduced well below 1.0, and the epidemic would collapse….Unlike sampling-based tests, population-scale testing does not need to be very accurate: false negative rates up to 15% could be tolerated if 80% comply with testing, and false positives can be almost arbitrarily high when a high fraction of the population is already effectively quarantined.

Similarly, Berger, Herkenhoff and Mongey conclude:

Testing at a higher rate in conjunction with targeted quarantine policies can (i) dampen the economic impact of the coronavirus and (ii) reduce peak symptomatic infections—relevant for hospital capacity constraints.

This is exactly the strategy I discussed in, Mass Testing to Fix the Labor Market, where I wrote “Testing, isolating and tracing will [get the economy back on track] much faster and cheaper than dealing with a prolonged recession.”

I want to expand on the costs because it’s clear that a mass testing regime will require millions of tests. Is that cost-effective? Yes. The two types of tests we have are a RT-PCR test for COVID-19 (there are several versions) which costs something like $100 but could probably be much less as we ramp up. (We can cut costs and greatly increase throughput, for example, by pooled testing.) The second test, a blood test for antibodies, is, as best as I can tell, in the realm of $10. Both types are useful. I am going to be very conservative and say that we use a combination of tests at $75 per test. To test the entire US population, therefore, it would cost on the order of $25 billion dollars. Coincidentally, $25 billion is about what we spent on the Manhattan Project in current dollars. Thus, I am proposing a Manhattan Project for testing.

Twenty five billion dollars to test the entire US population. Now suppose the pandemic knocks 5% off US GDP over the next year or two, that’s roughly a trillion dollars lost. Or to put it differently, $3 billion a day. Thus, if mass testing reduces the number of days we are away from work by 9, it pays for itself. Let’s again be conservative and say that testing will also require a $25 billion fixed cost to build the enzyme factories and so forth, for a total cost of $50 billion. 18 days and it’s worth it.

We would also save medical costs by suppressing the virus. (The focus on ventilators has perhaps been overdone given that ventilators in no way guarantee survival–better to stop people needing ventilators.) We would also save lives. Thus, a program of mass testing seems like a no-brainer. Yet, there is no direct funding for anything like this in the $2.2 trillion CARES bill which is stunning. Here’s Austan Goolsbee:

We literally put in a tax break for retailers and restaurants to expand their capacity but not money for production of more COVID tests.

Here’s Paul Romer:

We have an economic crisis because it is not safe for people to work or consume. Our Congress just passed a bill that will spend $2.2 trillion to deal with the crisis. Can anyone identify any spending in this bill devoted to making it safe for people to work and consume?

As I wrote:

We need to attack the virus with test, isolate, and trace. More money for counter-attack!

Objections will no doubt be raised. Isn’t there a shortage of reagents? Do we have the personnel to test everyone? To which I answer, $50 billion solves a lot of problems. We won’t know how many till we try. We don’t need all of final testing capacity at once and even poor tests like simple temperature checks will help but we need to move rapidly in the right direction. The main constraint is time. Social distancing and lock downs are starting to have an effect. I expect the emergency will peak in mid-April and then things will slowly start to get improve. Even when the worst of the emergency passes, however, we will still need lots of testing. This virus will be with us and the world for some time. Let’s get on it.

Are many more people infected than we think?

Here is the Clive Cookson FT piece (with an irresponsible headline).  Here is the Lourenco new Oxford study, only a few pp.  Miles Kimball offers analysis and numerous references.

Here is the Bendavid and Bhattacharya WSJ piece that perhaps has had the biggest popular influence.  They argue that many more people have had Covid-19 than we think, the number of asymptotic cases is very large, and the fatality of the virus is much lower than we think, perhaps not much worse than the flu.  But their required rate of asymptomatic cases is implausibly high.

The best evidence (FT) for asymptomatic cases ranges from 8 to 59 percent, and that is based on a number of samples from China and Italy, albeit imperfect ones.  Icelandic data — they are trying to sample a significant percentage of their population — suggest an asymptomatic rate of about 50 percent.  To be clear, none of those results are conclusive and they all might be wrong.  (And we should work much harder on producing better data.)  But so far there is no particular reason to think those estimates are wrong, other than general uncertainty.  You would have to argue that the asymptomatic cases usually test as negative, and while that is possible again there is no particular reason to expect that.  It should not be your default view.

Marc Lipitsch put it bluntly:

The idea that covid is less severe than seasonal flu is inconsistent with data and with the fact that an epidemic just gathering steam can overwhelm ICU capacity in a rich country like Italy or China.

Furthermore, the “optimistic” view implies a much faster spread for Covid-19 than would fit our data from previous viral episodes, which tend to come in waves and do not usually infect so many people so quickly.

So I give this scenario of a very low fatality rate some chance of being true, but again you ought not to believe it.  The positive evidence for it isn’t that strong, and you have to believe a very specific and indeed unverified claim about the asymptomatic cases testing negative, and also about current spread being unprecedentedly rapid.

Here is Tim Harford’s take (FT) on all this, he and I more or less agree.

By the way, Neil Ferguson didn’t walk back his predictions.  That was fake news.

So we still need to be acting with the presumption that the relatively pessimistic account of the risks is indeed true.  Subject to revision, as always.

But *when* will you favor a shift in coronavirus strategy? (no Straussians in a pandemic)

I agree with the numerous sentiments, for instance as expressed here by Ezra Klein, that we are not facing a dollars vs. lives trade-off, rather the better solutions will improve both variables.  Also read this Tom Inglesby thread.  Furthermore there is a concrete path forward toward general improvement, for instance read Zeke Emanuel (NYT, I don’t agree with every detail but the overall direction yes).  And don’t forget these costs cited by Noah.

But we are economists, not mood affiliators, and so we must address the classic question of “at what margin?”  At what margin would you favor an actual shift in strategy because the virus already had reached so many people?  And yes, such a margin does exist.  At that margin we would continue some of our defensive responses, but the overall approach would have to change away from the above links.

Let’s say everyone had been exposed to the coronavirus except yours truly.  Should we shut all (non-take out) restaurants just to limit my personal risk?  Clearly not.  And likely I would end up getting exposed sooner or later in any case.  Then you should “let it rip,” and let Tyler decide when he wishes to go outside or not (but of course offer him health care).

So what is the margin of bad outcomes where, after that point, a major change in strategy should set in?  Has to set in?  That is the question we all need to answer.  And what should that strategy change be exactly?

We like to say “speed is of the essence,” but a less frequent spoken corollary of that is “at some point it is too late to stage the defense we had been hoping for.”

What if we made no further progress against Covid-19 after two more weeks?  Three more weeks?  How about a bit of progress on testing across the next month and a modest increase in mask capacity?  How much longer is the cut-off?  Given how rapidly the virus spreads, it can’t be that long from now.  It cannot honestly be “four months from now.”

(For the record, I am still optimistic, but not at p = 0.8, so this eventuality is by no means purely hypothetical.  And it is perfectly correct to note that Trump’s own incompetence is to some extent making the whole dilemma come true, and that itself is deeply unsettling.  Agree!  We should have “gone Singapore” months ago.  But the dilemma is now here nonetheless, noting that we are hardly the only country in this bucket.  You can’t just condemn Trump and stop thinking about it.)

Or what if New York and seven other regions are hopeless but the rest of the country is not?

I am fine if you agree with me, Ezra, Tom Inglesby, Zeke Emanuel, and many others, including most of the Democratic Party public health establishment.  We all favor “speed is of the essence.”

But the next part of the message never quite gets delivered.  And no one wants to talk about what the next strategic stage — if we fail — should look like.

It is imperative that you consider where your line lies — if only mentally — when you would jump ship and indeed…confess a significant degree of defeat and then formulate and push for a new strategy.

Addendum: Straussian Tyler is not entirely comfortable with this post, as he, like his brother Tyrone, prefers to tell the Noble Lie and maintain the illusion that the preexisting struggle must continue across all margins and at all times.  But perhaps, these days, there are no Straussians in foxholes.  So pick your “no return” point, write it down, and then get back to me.  The honesty of our policy response requires this, yes?  I’m not even making you say it out loud.

And don’t you find it strange that no one has been willing to raise this point before?  Could it be that we are not being told the entire truth?  Or are people not telling the entire truth to themselves?  Isn’t that the same mistake we’ve been making all along?

Let the Markets Work

Many people are calling for the President to use the Defense Productions Act (DPA) but the reality is that the DPA is neither especially useful nor necessary. The markets are already redirecting resources in a rapid and sophisticated manner. For the most part, the shortages were due to temporary increases in demand. The shelves are now filling. Food is plentiful. Hand sanitizer and soap is on the way or available. We are not going to run out of toilet paper. Now that the CDC and the FDA have gotten out of the way, we are producing more tests.

Honeywell and 3M are already ramping up production of N95 masks. We should arrange with China to buy more. The Federal Government is playing a useful role by buying surgical masks from companies like Hanes. Ironically, we will be importing them from Latin America.

Winston-Salem Journal: The company went from negotiating a contract with the federal government to beginning production in less than a week, according to the spokesman.

Using U.S.-grown cotton, the masks are being produced in Hanesbrands’ sewing factories in El Salvador, Honduras and the Dominican Republic.

These factories would normally be producing T-shirts, underwear, socks, sweatpants and sweatshirts.

(Note the stupid requirement to use American Cotton.)

A price is a signal wrapped up in an incentive, as Tyler and I write in Modern Principles. Compare the price system with command and control. We need ventilators. The federal government could order ventilator firms to make more but they are already doing so. The government could order other firms to get into the ventilator business but does the Federal government have a good idea which firms have the right technology or which firms have the right technology that could be repurposed to ventilator production at low cost, that is without causing shortages and disruption in other fields? Can they do better than a decentralized process in which millions of entrepreneurs respond to price signals. No.

A word here on “price gouging.” There are two kinds. The first, which has gotten some attention, is when the manufacturer/retailer holds the price constant despite increased demand and an enterprising fellow buys up stock to sell at the true market price–the ticket scalping model. “Ticket scalping” has some good features and I would not make it illegal but it has one big problem–the benefits of the increased price are not going to the producers. It would be better if the manufacturer and retailer raised their prices, the scalpers would then be eliminated and the benefits of the higher price would flow to producers giving them an incentive and resources to expand production. We shouldn’t worry too much about ticket scalping, however, because its temporary. Typically what happens is that the manufactures and retailers hold the price low for a short period of time to avoid consumer backlash, output ramps up, and then the price rises but given the increased supply by not as much as it would have in the short run. This also works fine. The bottom line is that it’s very important that manufacturer prices be allowed to rise to reflect true scarcities and to get resources flowing in the right direction. So far, we are doing that and the system is working well.

If all the trucks are fleeing from the front, we want the army to be able to requisition vehicles to move in the opposite direction. Private and social incentives do not always align and when time and certainty are of the essence command and control may be superior (as Tyler and I discuss in Modern Principles in the chapter on externalities). For the most part, however, that is not the situation we are in now. Private incentives are all pushing in the right direction of greater production. Let the market respond. The federal government is not good at command and control but it does have a role to play in redistribution for need.

America’s great strength is decentralization and markets, and right now we need our strength.

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 prizeHelen 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 reportedWhite 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 responseCurative, 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.

$1 million plus in Emergent Ventures Prizes for coronavirus work

I believe that we should be using prizes to help innovate and combat the coronavirus. When are prizes better than grants? The case for prizes is stronger when you don’t know who is likely to make the breakthrough, you value the final output more than the process, there is an urgency to solutions (talent development is too slow), success is relatively easy to define, and efforts and investments are likely to be undercompensated. All of these apply to the threat from the coronavirus.

We do not know who are the most likely candidates to come up with the best tests, the best remedies and cures, the best innovations in social distancing, and the best policy proposals. Anyone in the world could make a contribution to the anti-virus effort and it won’t work to just give a chunk of money to say Harvard or MIT.

Progress is urgent. I am still keen on talent development for this and other problems, but the situation is worse every week, every day. It is important to incentivize those who are working on these problems now.

The innovators, medical professionals and policy people at work on this issue are unlikely to receive anything close to the full social value of their efforts.

I therefore am grateful that I have been able to raise a new chunk of money for Emergent Ventures — a project of the Mercatus Center — for ex post prizes (not grants) for those who make progress in coronavirus problems.

Here are the newly established prizes on offer:

1. Best investigative journalism on coronavirus — 50k

2. Best blog or social media tracking/analysis of the virus — 100k

3. Best (justified) coronavirus policy writing — 50k

4. Best effort to find a good treatment rapidly — 500k, second prize 200k

5. Best innovation in social distancing — 100k

6. Most important innovation or improvement for India — 100k

What might be an example of a winning project?  What if this attempt to build scalable respirators succeeded?  That would be a natural winner.  Or a social distancing innovation might be the roll out of more meals on wheels, little libraries, online worship, easier ways to work from home, and so on.  The vision is to give to people whose work actually will be encouraged, not to give to Amazon (sorry Jeff!), no matter how many wonderful things they do.

These are not prizes you apply for, they will be awarded by Emergent Ventures when a significant success is spotted.  (That said, you still can propose a coronavirus-related project through normal channels, with discretionary amounts to be awarded as grants per usual procedures.)  And typically the awards will apply to actions taken after the release of this announcement.

I would love to be able to offer more second and third prizes for these efforts, and also to increase the amounts on offer, and perhaps cover more countries too. Or perhaps you have an idea for an additional category of prize. So if you are a person of means and able to consider making a significant (tax-deductible) contribution, please email me and we can discuss.

In the meantime, the rest of you all need to get to work.

MRU and the Coronavirus

Many universities are moving rapidly to teach online. Tyler and I and the entire team at MRU want to do everything we can to help make the process as successful as possible not just to improve education but to help to reduce the threat from COVID-19.

First, we have created a Resources Page on Teaching Online at that page you can also find a Facebook Community Page where educators are providing lots of tips and resources not just on videos but on how to use Zoom and other tools. Here, for example, is an excellent twitter thread on teaching online from Luke Stein that covers hardware, software, and techniques.

Second, If you are using Modern Principles, our textbook, and want to move online, Macmillan will do that for you for free, very rapidly, and including online tests, homework etc. If you want to move online from a different book, send Tyler or myself an email and we can discuss the best ways to do that.

Third, MRU has hundreds of videos which are free for anyone to use. Most notably our courses on Principles of Microeconomics and Principles of Macroeconomics but a lot more as well. You can search for MRU videos here. Here is a “greatest hits” list.

MRU is, of course, not the only source of excellent teaching material. Here are some others:

One place to begin might be to explain to your students the mathematics of why universities and schools are closing despite relatively few deaths to date in the United States. As always, this 3Blue1Brown video is excellent.

Addendum: See also Tyler’s important announcement on EV Prizes.